Childhood sexual abuse and revictimization in adolescence

Prevalence and determinants of sexual abuse among adolescent girls during the COVID-19 lockdown and school closures in Ghana: A mixed method study

BACKGROUND

In the wake of the COVID-19 pandemic, concerns have been raised that the pandemic may derail global efforts against child sexual abuse (CSA).

OBJECTIVES

This study examines the prevalence and associated factors of sexual abuse among adolescent girls in the context of the COVID-19 pandemic in Ghana.

PARTICIPANTS AND SETTING

The sample comprised 853 adolescent girls aged 13-19 (16.03 ± 2.04 years) in Ghana.

METHODS

The study employed a concurrent mixed-method design.

RESULTS

Overall, the prevalence of CSA during the COVID-19 lockdown and school closures was 32.5 %. Protective factors for CSA were feeling safe in neighbourhood (AOR = 0.526, 95 % CI = [0.325, 0.850]) and parents often listen to opinions (AOR = 0.446, 95 % CI = [0.241, 0.826]). Risk factors for CSA were physical activity (AOR = 1.649, OR = 1.783, 95 % CI_AOR = [1.093, 2.487, 95 % CI_OR = [1.241, 2.561]), parents sometimes listen to opinions (AOR = 1.199, OR = 1.924, 95 % CI_AOR = [0.504, 2.853], 95 % CI_OR = [1.034, 3.582]), living with another relative (AOR = 2.352, OR = 2.484, 95 % CI_AOR = [0.270, 20.523], 95 % CI_OR = [0.317, 19.475]), Akan ethnicity (AOR = 1.576, OR = 1.437, 95 % CI_AOR = [0.307, 8.091], 95 % CI_OR = [0.316, 6.534]), having no disability (AOR = 1.099, OR = 1.138, 95 % CI_AOR = [0.679, 1.581], 95 % CI_OR = [0.786, 1.649]) and having a close relationship with parents (AOR = 1.334, OR = 1.752, 95 % CI_AOR = [0.746, 2.385], 95 % CI_OR = [1.096, 2.802]).

CONCLUSION

Knowledge of the risk and protective factors identified in this study can guide and inform the development of CSA prevention programmes during disruptive occurrences like school closures and lockdown.

Sexual Violence Suffered by Women in Early and Late Adolescence: Care Provided and Follow-Up

OBJECTIVE

 To compare the sexual violence suffered by women in early and late adolescence, the reactions triggered after the aggression, and the care provided.

METHODS

 A retrospective study in which we reviewed the medical records of 521 female adolescents treated by a multidisciplinary team at a reference hospital in the city of Campinas, state of São Paulo, Brazil. We analyzed sociodemographic variables, and those pertainin to the characteristics of the episodes of violence, the emergency care, and the physical and psychological reactions observed during the follow-up. For the analysis, the sample was divided into groups of early (10 to 14 years) and late (15 to 18 years) adolescence. We used the Chi-squared/Fisher Exact, Mann-Whitney, and Kruskal-Wallis tests to compare the groups; the level of significance adopted was 5%.

RESULTS

 The early group (n = 242) contained more adolescents who were enrolled in school (p < 0.001), suffered more daytime aggressions (p = 0.031), in their residences (p < 0.001), by an aggressor with whom they were acquainted (p < 0.001), had greater need of legal protection (p = 0.001), and took longer to seek care (p = 0.048). Feelings of guilt, shame, and the perception of violence were similar between the groups. In the late group (n = 279), there was greater consumption of alcohol during the aggression (p = 0,005); they received significantly more prophylaxis treatments; reported more physical symptoms (p = 0.033), sleep disorders (p = 0.003), symptoms of anxiety (p = 0.045), and feelings of anguish (p = 0.011); and had more prescriptions of psychotropics (p = 0.005). Only 52% completed the 6-month follow-up, with no differences between the groups.

CONCLUSION

 The age groups showed differences in the characteristics of the episodes of violence; early adolescents took longer to seek help, and the late group presented more intense symptoms and psychological worsening during the follow-up. Measures of prevention and specific care aimed at this population are needed.

Seeking Help From Formal Sources Among Teen Dating Violence Victims: Exploring the Role of Incident and Victim Characteristics

Most teen dating violence (TDV) victims do not seek help after their victimization experience. While research has identified that victims are more likely to turn to informal versus formal sources, there is a lack of knowledge about what factors are predictive of help-seeking from formal sources. The current study explored the impact of incident and victim characteristics on help-seeking from formal sources among middle and high school TDV victims (N = 2,174). Findings indicate that the severity and location of the victimization significantly increase the likelihood of help-seeking from formal sources.

Posttraumatic Stress Symptoms and Coping Motives Mediate the Association Between Childhood Maltreatment and Alcohol Problems

Childhood maltreatment is associated with increased risk of alcohol misuse. Posttraumatic stress symptoms (PTSS) and coping motives have both been identified, separately, as mediators of the relation between childhood maltreatment and alcohol misuse but have yet to be examined as serial mediators in a high-risk population. A total of 564 adolescents (53.7% female; M age = 15.9 years, SD = 1.1) in the care of child welfare services completed validated measures of childhood trauma, PTSS, drinking motives, and alcohol misuse across the first two waves (baseline and 6-month follow-up) of the Maltreatment and Adolescent Pathways (MAP) longitudinal study. Childhood maltreatment was associated with elevated PTSS, PTSS predicted higher coping motives, and coping motives were associated with higher levels of alcohol misuse, indirect effect (IE) = 0.03; 95% CI [0.00, 0.07]. Single mediator models with PTSS, IE = 0.03; 95% CI [-0.01, 0.05], and coping motives, IE = -0.02, 95% CI [-0.05, 0.03], as mediators were not statistically significant. The results suggest that PTSS and coping motives contribute sequentially to the association between childhood maltreatment and alcohol misuse and could thus both serve as intervention targets to prevent problem drinking in maltreated youth.

Psychological Distress and Revictimization Risk in Youth Victims of Sexual Abuse

Psychological distress, including depression and anxiety, has been associated with increased risk for sexual revictimization in youth who have experienced child sexual abuse. The present study utilized assessment information from treatment seeking youth with histories of sexual abuse to explore specific risk indicators for revictimization-risk taking, social problems, maladaptive cognitions, and posttraumatic stress-that may be indicated by self-reported distress. The relationship between initial levels of distress and change in symptoms over a 12-week course of treatment was also explored. Participants were 101 youth referred to a child-focused therapeutic group for victims of sexual abuse, 65 youth referred to an adolescent-focused group, and their non-offending caregivers. Results revealed that when combined into a distress score, depression and anxiety were associated with delinquent behaviors, interpersonal difficulties, maladaptive cognitions, and posttraumatic stress symptoms for child and adolescent group participants at presentation to treatment. Children exhibited improvement on measures of interpersonal difficulties, maladaptive cognitions, and self-reported posttraumatic stress disorder (PTSD) symptoms. Adolescents exhibited less change over time, with significant improvement on self-reported social problems and PTSD only. Higher psychological distress was associated with less improvement in regard to negative expectations of abuse impact for child group participants. The findings suggest that distress indicates the presence of specific revictimization risk indicators, helping to identify targetable symptoms for intervention. Therefore, screening for psychological distress after discovery of sexual abuse may help detect youth at higher risk for revictimization and guide treatment.

The high prevalence of pre-existing mental health complaints in clients attending Saint Mary's Sexual Assault Referral Centre: Implications for initial management and engagement with the Independent Sexual Violence Advisor service at the centre

BACKGROUND

The Saint Mary's Sexual Assault Referral Centre has a unique service delivery model whereby it provides an integrated physical and psychological support services to clients, women men and children, living in Greater Manchester. The service is available to those who have reported rape or sexual assault, whether this is recent or historic. Clients living in surrounding areas of Cheshire are provided with forensic and medical services at Saint Mary's Centre, with follow-up care provided locally, as appropriate.

AIMS

The primary objective was to identify the prevalence of self-reported pre-existing mental health complaints amongst adult clients who attended Saint Mary's Centre for a forensic medical examination. The secondary objective was to consider levels of engagement with the Centre's Independent Sexual Violence Advisor service by comparing clients who reported a mental health complaint to clients who did not.

METHOD

One-hundred and eighty sets of client's notes from 2016 were retrospectively analysed. Client inclusion criteria were that they were (a) over the age of 18 years when attending the Centre, (b) had attended for a forensic medical examination.

RESULTS

69% of clients analysed reported a pre-existing mental health complaint. The time taken for clients to present to Saint Mary's Centre following a reported assault tended to be later for the clients with self-reported mental health problems than those without. However, there was no difference in the long-term engagement with the Centre's Independent Sexual Violence Advisor service at the Centre between the two groups.

CONCLUSION

Prevalence of self-reported pre-existing mental health complaints is extremely high in clients presenting at Saint Mary's Centre as compared to national and regional prevalence rates for mental health complaints in the general population. The vulnerability of this client group should be considered when they attend a SARC and support provided should be appropriate and accessible to their needs. Staff should have adequate training and supervision to be able to respond in this way.

Sexual Violence against Women in Germany: Prevalence and Risk Markers

Previous research has repeatedly shown that gender-based violence affects a considerable proportion of women in any given population. Apart from providing current estimates of the prevalence of sexual violence against women in Germany, we identified specific risk markers applying an advanced statistical method. We analyzed data from a survey of N = 4450 women representative of the German population, conducted by the Criminological Research Institute of Lower Saxony in 2011. Lifetime prevalence for experiencing sexual violence was 5.4% for women aged 21–40 years (five-year prevalence: 2.5%). Non-parametric conditional inference tree (C-Tree) analyses revealed that physical and sexual abuse during childhood as well as being divorced, separated, or widowed was the most informative constellation of risk markers, increasing the five-year prevalence rate of experienced sexual violence victimizations up to 17.0%. Furthermore, knowing about the official penalization of marital rape was related to a lower victimization risk for women without a history of parental violence. Possible explanations for these findings as well as implications for future research are critically discussed.

Predicting Sexual Revictimization in Childhood and Adolescence: A Longitudinal Examination Using Ecological Systems Theory

A substantial proportion of sexual abuse victims report repeat sexual victimization within childhood or adolescence; however, there is limited understanding of factors contributing to revictimization for youth. Thus, the present study examined predictors of sexual revictimization prior to adulthood using ecological systems theory. Records of 1,915 youth presenting to a Child Advocacy Center (CAC) were reviewed to identify individual, familial, and community factors as well as initial abuse characteristics associated with risk for revictimization. Results showed that 11.1% of youth re-presented to the CAC for sexual revictimization. At the individual level, younger children, girls, ethnoracial minority youth, and those with an identified mental health problem were most likely to experience revictimization. Interpersonal factors that increased vulnerability included the presence of a noncaregiving adult in the home, being in mental health treatment, and domestic violence in the family. Community-level factors did not predict revictimization. When factors at all levels were examined in conjunction, however, only individual-level factors significantly predicted the risk for revictimization. Findings from this study provide valuable information for CACs when assessing risk for re-report of sexual abuse and add to the field's understanding of revictimization within childhood.

Social Support of Adolescent Survivors of Child Sexual Abuse and Sexual Revictimization in Turkey

Sexual revictimization refers to having a history of child sexual abuse and an experience of being assaulted again in adolescence or adulthood. This descriptive study examined perceived social support of nonvictim adolescents and adolescents who had survived single sexual abuse and sexual revictimization. Participants were 210 adolescent girls, all aged between 15 and 18, selected by a convenience sampling method; 70 had survived sexual revictimization, 70 had survived single sexual abuse, and 70 were nonvictims. The Perceived Social Support Scale was administered, and a one-way ANOVA was conducted for data analysis. Perceived social support from the community was lower in the sexual revictimization group than in the single sexual abuse and comparison groups. Family social support did not differ between the sexual revictimization and single sexual abuse groups but was lower in both than in the comparison group. These results indicate that victims of sexual revictimization need social support, and both sexual revictimization and single sexual abuse victims need familial support.

Childhood Sexual Abuse and Later Alcohol-Related Problems: Investigating the Roles of Revictimization, PTSD, and Drinking Motivations Among College Women

The current study sought to examine whether symptoms of posttraumatic stress disorder (PTSD), adolescent sexual assault (ASA), and drinking motivations (e.g., drinking to regulate emotional experiences) mediate the relationship between a history of childhood sexual abuse (CSA) and subsequent alcohol-related problems among college women. Participants were 579 female students at a Midwestern university. Participants were recruited as part of a larger longitudinal study that investigated risk and resiliency factors related to sexual revictimization. Using a serial mediation model, the current study found that the proposed constructs mediated the relationship between CSA and subsequent alcohol-related problems via two separate paths. In one path, CSA was associated with PTSD, which in turn predicted drinking to regulate emotional experiences, which then was related to alcohol-related problems in adulthood. In the second path, CSA was related to ASA, which in turn predicted drinking to regulate emotional experiences, which then was related to alcohol-related problems in adulthood. These results suggest that individuals with a history of CSA are more likely to experience both revictimization in adolescence and PTSD symptoms in adulthood, which may lead to alcohol-related problems via drinking to regulate emotional experiences. These findings suggest the importance of incorporating skills training in adaptive emotion regulation strategies into treatment for individuals with a history of CSA and ASA.

From Sexual Assault to Sexual Risk: A Relational Pathway?

Among women and gay and bisexual men, sexual assault is associated with increased rates of sexual risk behavior and negative sexual health outcomes. Although the mechanisms of these effects are potentially myriad, the current analyses examine the role of perceived partner pressure for condomless sex in mediating the association between adult sexual assault (ASA) and recent anal or vaginal sex without a condom. In a sample of 205 young adult women and gay and bisexual men, ASA was indirectly associated with condomless anal and/or vaginal sex via perceptions of partner pressure for condomless sex, χ²(1) = 5.66, p = .02, after controlling for race, age, gender and sexual identity, and relationship status. The elucidation of this relational mechanism points to several potential intervention and prevention strategies that may reduce actual and perceived pressure for sex without a condom, including strategies designed to facilitate the prioritization of health and safety over relational goals and the improvement of partner selection and perceptions of partner pressure.

Predicting Sexual Assault Revictimization in a Longitudinal Sample of Women Survivors: Variation by Type of Assault

This study used a large community sample of women sexual assault survivors to prospectively assess 17 theorized predictors across four types of sexual assault revictimization: unwanted contact, coercion, substance-involved assault (SIA), and force. Results indicated that predictors varied across types of revictimization: Unwanted contact and coercion appeared more common in social contexts more hostile toward survivors, whereas forcible assaults and SIAs occurred in circumstances where survivors were vulnerable to being targeted by perpetrators. Overall, the strongest predictors were social environments hostile to survivors, race, childhood sexual abuse, decreased refusal assertiveness, and having more sexual partners. We discuss implications for intervention and research.

The Relationship Between Parents' Violence Against Daughters and Violence by Other Perpetrators

This article examines the links between violence perpetrated by parents and subsequent victimization in a sample of 510 Italian women attending different health and social services, using both quantitative and qualitative data. Almost one quarter of the respondents reported some kind of abuse by one or both parents, fathers' violence being more common than mothers'; 9.6% had suffered subsequent sexual violence, and 18.2% had experienced partner violence. Violence by one or both parents during childhood—especially mothers' violence—was associated with an increased risk of suffering from sexual violence and from partner violence.

Sexual Harassment among Female Personnel in an Italian Hospital

A study investigating sexual harassment was conducted among 265 female hospital workers in Italy. Three types of sexual harassment were studied: gender harassment, unwanted sexual attention, and sexual coercion. In the 12 months preceding the study, 42% of the respondents had experienced at least one type of harassment from colleagues, 29% from patients, and 54% from both. Sexual coercion was reported by 3% of respondents and was perpetrated only by colleagues. Harassment by colleagues was more common among women in authority positions and among women with financial worries or recent domestic violence. Harassment by patients was more common among nurses and night shift workers.

Risk Factors for Sexual Victimization of Women

Using data drawn from a prospective study of 206 urban, predominantly low-income, African American women, sexually victimized before they turned 13 in the early 1970s, and a matched comparison group, this article explores whether child sexual abuse was a risk factor for revictimization and examines the role of other factors in the risk of victimization. Child sexual abuse before the age of 13 was not by itself a risk factor for adult victimization, but those who were also victimized as adolescents were at much greater risk of adult sexual victimization than other women. Additional risk factors included measures of sexual behavior and alcohol problems.

Do Sexual Health Care Needs Differ for Women with and without Histories of Abuse?

Information is limited regarding sexual concerns and sexual health care needs of women who have experienced abuse. This study compares sexual concerns as well as interest and experience in discussing these concerns with physicians for women with and without a history of abuse. Nearly all women reporting abuse had sexual concerns and, specifically, a significantly higher intensity of decreased sexual interest than women not experiencing abuse. Women reporting abuse see physicians as a resource for their sexual health needs. Although they were more likely to raise the topic than women not reporting abuse, they clearly prefer that physicians initiate the topic.

Pathways from childhood abuse to prospective revictimization: depression, sex to reduce negative affect, and forecasted sexual behavior

Research suggests that adverse events in childhood, such as childhood physical, sexual, and emotional abuse, confer risk for later sexual assault. Psychological distress, coping strategies, and sexual behavior may help explain the path from childhood abuse to revictimization. The present study explored how the use of sex to regulate negative affect (SRNA) operates independently, and in combination with other psychosocial factors to increase college women's (N=541) risk of experiencing prospective adult sexual assault (ASA). Sequential multiple mediator models in Mplus were used to assess the effect of three different forms of childhood abuse on prospective ASA, both independently and while controlling for other forms of childhood abuse. The indirect effect of adolescent sexual assault (AdolSA), depressive symptoms, SRNA, and participants' response to a sex-related vignette was tested using bias-corrected bootstrapping. In the full path model, childhood emotional abuse and AdolSA predicted ASA, while childhood physical and sexual abuse were directly associated with AdolSA, but not ASA. Additionally, depressive symptoms and participants' estimate of their likely behavior in a sex-related vignette directly predicted prospective ASA. Results using bootstrapping revealed that a history of childhood abuse predicted prospective ASA via diverse direct and indirect paths, as well as through a similar multiple mediator path. Overall, findings suggest that a combination of affective, coping, and sexual expectancy factors contribute to risk for revictimization in adult survivors of childhood abuse. Future research directions and targets for risk-reduction programming are discussed.

The role of ethnicity, sexual attitudes, and sexual behavior in sexual revictimization during the transition to emerging adulthood

An experience of child sexual abuse (CSA) substantially increases women's risk of adult sexual assault (ASA), but the mechanisms underlying this relationship are unclear. Previous research often has not examined the full range of ASA experiences or included the influence of ethnicity, sexual behavior, and sexual attitudes on CSA and severity of ASA. The current study utilized path analysis to explore the relationships among ethnicity, sexual attitudes, number of lifetime sexual partners, CSA, and severity of ASA in emerging adult women. Results indicated a significant relationship between CSA and more severe ASA that was partially explained by having more lifetime sexual partners. Additionally, European American women, relative to Hispanic women, reported more severe victimization, which was fully explained by more positive attitudes toward casual sex and having more lifetime sexual partners. These results have implications in the design and implementation of universal and selective prevention programs aimed at reducing ASA and revictimization among emerging adult women.

Strong association between earlier abuse and revictimization in youth

Background

Violence victimization among youth is recognized as a public health problem. The objective was to analyze the risk pattern of emotional, physical, and sexual abuse during the past 12 months by gender, sociodemographic factors, health risk behaviors, and exposure to abuse before the age of 15, among young men and women attending youth health centers in Sweden.

Methods

A cross-sectional survey was conducted using a nationally representative sample of youth health centers. A total of 2,250 young women and 920 young men aged 15–23 completed a self-administered questionnaire. Odds ratios (OR) and adjusted odds ratios (AOR) with 95% CI were calculated.

Results

A consistent and strong association was noted between exposure to all types of violence during the past year and victimization before the age of 15 for all types of violence for both women and men. The only exceptions were childhood sexual victimization and sexual violence during the past year for men. Younger age was associated with all violence exposure for the women and with emotional violence for the men. For the women, drug use was associated with all types of violence, while the association with hazardous alcohol use and not living with parents was restricted to physical and sexual violence exposure, present smoking was restricted to emotional and physical violence exposure, and partnership and living in urban areas were restricted to sexual violence. For men, not being partnered, hazardous alcohol consumption, and drug use meant increased risk for physical violence, while smoking and living in urban areas were associated with sexual violence. After adjustment, immigration had no association with violence exposure.

Conclusions

Violence victimization in young men and women is often not a single experience. Findings underline the importance of early interventions among previously abused youth.

Gendered experiences of sexual abuse of teenagers and children in Mexico

The prevalence of sexual abuse during childhood and adolescence in a national representative sample of Mexican youngsters is examined from a gender perspective using data from the 2007 National Survey on Exclusion, Intolerance and Violence in Public Institutions of High School Level Education. Of those surveyed, 1.76% were forced into their first experience of intercourse, and 6.43% had their genitalia touched or their first sexual interaction imposed against their will. In this sample, 6.82% had experienced sexual abuse before the age of 18. Child sexual abuse was most commonly perpetrated by family members and neighbors. Only 20% reported being abused by an unknown person. Males and females had different victimization experiences. Forty percent disclosed information about the abuse to another person, and 7% reported their experiences to law enforcement agencies. Males and females stated different reasons for not disclosing. These findings are discussed within the context of the social construction of the male and female body and sexuality in the Mexican context.

Characterizing the sexual abuse experiences of young adolescents

The purpose of this descriptive study was to: (a) compare the demographics of maltreated youth initially labeled as sexually abused by the Department of Child and Family Services (DCFS) to maltreated youth classified as sexually abused using current and past case records, (b) identify differences in sexual abuse experiences and types of perpetrators between boys and girls, and (c) provide a detailed description of the sexual abuse experiences for boys and girls. Participants were youth ages 9-12 years old with a recent maltreatment allegation. The Maltreatment Case Record Abstraction Instrument (MCRAI) was used to code child welfare records of 303 maltreated youth of whom 60 experienced sexual abuse. Perpetrators were classified by gender into four categories (biological parent, parental figure, relative, and unrelated) and type of abuse was classified into three categories (penetrative, contact without penetration, and non-contact). Using Chi-Square tests, perpetrator categories and sexual abuse types were compared by child gender for significant differences. Only 23 (38.3%) of the 60 sexually abused youth were labeled as sexually abused in the most recent DCFS report when they entered the study. About three-quarters of the sexually abused youth experienced non-penetrative physical contact, 40% experienced penetration, and 15% experienced sexual abuse without physical contact. Most youth (91.7%) were victimized by a male, and 21.7% were abused by a female. Youth experienced a large range of sexual abuse experiences, the details of which may be important for exploration of consequences of childhood sexual abuse.

Testing a multiple mediator model of the effect of childhood sexual abuse on adolescent sexual victimization

The present study modeled the direct relationship between child sexual abuse (CSA) and adolescent peer-to-peer sexual victimization (APSV) and the mediated effect via variables representing the number of sexual partners, sexual risk behavior, and signaling sexual boundaries. A cross-sectional study on the effect of CSA on APSV was conducted, utilizing a multiple mediator model. Mediated and direct effects in the model were estimated employing Mplus using bootstrapped percentile based confidence intervals to test for significance of mediated effects. The study employed 327 Danish female adolescents with a mean age of 14.9 years (SD = 0.5). The estimates from the mediational model indicated full mediation of the effect of CSA on APSV via number of sexual partners and sexual risk behavior. The current study suggests that the link between CSA and APSV was mediated by sexual behaviors specifically pertaining to situations of social peer interaction, rather than directly on prior experiences of sexual victimization. The present study identifies a modifiable target area for intervention to reduce adolescent sexual revictimization.

Sexual victimization among Spanish college women and risk factors for sexual revictimization

Sexual revictimization is frequent among victims of child sexual abuse. Several variables, such as sexual experience, substance abuse, and sexual assertiveness, have been proposed to explain the link between child sexual abuse and adolescent and adult sexual victimization, although they have typically been tested separately. The main objective of this study was to analyze which of these variables better explains the revictimization phenomenon using a multiple mediation analysis. The study also tested the frequency of sexual victimization experiences in a Spanish sample of college women. Four hundred and two women were interviewed. Results showed that 30.4% of them engaged in undesired sexual contact while almost 4% were victims of rape. The most frequent perpetrators were partners or ex-partners, acquaintances, or dating partners, but not strangers. Finally, the relationship between child sexual abuse and adolescent and adult sexual victimization was mediated by number of consensual sexual partners and sexual assertiveness. Results reflect some cultural differences from previous research.

Motivations for body piercings and tattoos - the role of sexual abuse and the frequency of body modifications

Though the popularity of body modification increases, psychosocial data about practitioners of body piercing and tattooing are few and controversial. Most studies used semi-structured interviews and relatively small sample sizes. The aim of this study was to explore psychosocial background information (motivation, sexual abuse) for body modification practises based on a sufficiently large sample. A core group of 432 subjects with body piercings and/or tattoos (readers of a specialised magazine on body modification; mean age: 28 years) was investigated in this study using a 55-item questionnaire. The mean number of body modifications (piercings and tattoos) was nine. Participants with a history of sexual abuse and high users with more than 10 body modifications differed from those without these features with respect to several motivations and consequences of body modification. Participants with sexual abuse often stated that they wanted to overcome certain experiences, and high users were characterised by the feeling of an addiction to continue body modification. Clinicians should include questions on body modifications and their motives in anamnestic schedules.

Childhood sexual abuse associated with dating partner violence and suicidal ideation in a representative household sample in Hong Kong

This study investigated the prevalence and impact of childhood sexual abuse (CSA) on future intimate partner violence (IPV) in dating relationship in Hong Kong, China. A total of 1,154 Chinese adult respondents engaged in dating relationships were interviewed face-to-face about their CSA histories, childhood witnessing of parental violence, adult sexual victimization (ASV) by others and IPV victimization with their current dating partner. Self-reports also measured levels of suicidal ideation, self-esteem, and demographic details. Overall, 1.7% reported some form of CSA with a higher percentage being women. No gender differences were found in the prevalence of either ASV or IPV. Results showed that CSA had an independent effect on physical IPV and suicidal ideation. The odds of IPV were increased by behavioral and psychological factors of victims such as alcohol and drug abuse, sex with partner, and low self-esteem. The odds of suicidal ideation were also increased by drug abuse, childhood witnessing of parental psychological aggression, and low self-esteem. Clinical implications of results included screening for CSA victims and suicidal victims when treating IPV patients, tailoring treatment according to individual IPV victim's problems, correcting behaviors that are associated with risks of IPV, such as engagement in casual sex and substance abuse, and focusing not only on tangible services but also on the social and psychological aspects that are placing the victims at risk for IPV.

Child abuse, early maladaptive schemas, and risky sexual behavior in college women

Previous research suggests that individuals abused as children are more likely to engage in risky sexual behavior during adulthood. The present study examined early maladaptive schemas as mediators of the child abuse-risky sexual behavior relationship among 653 college women. Self-report surveys assessed three forms of child abuse: Sexual, physical, and emotional, and assessed early maladaptive schemas within two domains: Disconnection/rejection and Other-Directedness. Disconnection/rejection schemas fully mediated the relation between child emotional abuse and number of sexual partners and partially mediated the relationship for sexual and physical abuse. However, when frequency of specific risky sexual acts (e.g., sex without contraception) was examined in the previous six months, only abandonment was a partial mediator. Implications for intervention and future research are discussed.

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.

The development and psychometric assessment of the adolescent sexual coercion risk scale

The objective of this study was to develop a psychometric measure of risk for sexual victimization from adolescent peers. Items were generated on the basis of the literature and on consultations with a multidisciplinary group of key informants. The items were administered to a sample of 327 female Grade-9 students and examined using exploratory factor analysis. The Adolescent Sexual Coercion Risk Scale items formed two lower-order factors composed of items regarding signaling sexual boundaries and displaying risk behaviors, respectively. Subsequent confirmatory factor analysis supported the two factors, and preliminary psychometric analyses demonstrated that the factors have satisfactory internal consistency. In addition, low scores on the ability to signal sexual boundaries and high scores on risk behaviors were associated with self-reported peer sexual victimization, supporting the validity of the factors as measures of risk. Future validation and potential usage of the measure are discussed.

Emotion dysregulation and risky sexual behavior in revictimization

OBJECTIVE

The current study examined emotion dysregulation as a mechanism underlying risky sexual behavior and sexual revictimization among adult victims of child sexual abuse (CSA) and child physical abuse (CPA).

METHODS

Participants were 752 college women. Victimization history, emotion dysregulation, and risky sexual behavior were assessed with anonymous, self-report surveys utilizing a cross-sectional design.

RESULTS

Approximately 6.3% of participants reported CSA, 25.5% reported CPA, and 17.8% reported rape during adolescence or adulthood. CSA and CPA were associated with increased risk for adolescent/adult rape; 29.8% of CSA victims and 24.3% of CPA victims were revictimized. Path analytic models tested hypothesized relationships among child abuse, emotion dysregulation, adolescent/adult rape and three forms of risky sexual behavior (e.g., failure to use condoms, contraception, or having sex with someone under the influence of alcohol/drugs), including frequency of risky sexual behavior with a regular dating partner, with a stranger, and lifetime number of intercourse partners. Emotion dysregulation mediated revictimization for both CSA and CPA. Emotion dysregulation also predicted lifetime number of sexual partners and frequency of risky sex with a stranger, but not frequency of risky sex with a regular dating partner.

CONCLUSIONS

Findings suggest that emotion dysregulation is a distal predictor, and risky sex, particularly with lesser known partners, is a proximal predictor of sexual revictimization. Because emotion dysregulation also maintained a significant direct path to revictimization, risky sexual behavior appears to be one of several proximal risk factors for revictimization.

PRACTICE IMPLICATIONS

Findings confirm that emotion dysregulation is a critical pathway to more proximal risk factors such as risky sexual behavior, and suggest that clinical interventions aimed at improving emotion dysregulation may help reduce risky sexual behavior and risk for revictimization.

Sexual risk-taking among high-risk urban women with and without histories of childhood sexual abuse: mediating effects of contextual factors

This study investigated the mechanisms of risk for urban women at high risk for HIV with and without childhood sexual abuse histories. Childhood sexual abuse survivors reported more unprotected intercourse and sexually transmitted infections (STIs). The association of STI locus of control with frequency of unprotected sex was fully mediated by being intoxicated during sex and engaging in sex work, whereas the association between relational control and unprotected sex was not mediated by contextual factors for the childhood sexual abuse group. The mechanisms of risk are different for those with divergent childhood sexual abuse histories and thus interventions should be developed to educate women with a history of childhood sexual abuse about ways to avoid revictimization, particularly within a context of poverty, prostitution, and drug use.

Child sexual abuse, post-traumatic stress disorder, and substance use: predictors of revictimization in adult sexual assault survivors

This study examined the unique effects of child sexual abuse simultaneously with post-traumatic stress disorder symptom clusters, problem drinking, and illicit drug use in relation to sexual revictimization in a community sample of female adult sexual assault victims. Participants (N=555) completed two surveys a year apart. Child sexual abuse predicted more post-traumatic stress disorder symptoms in adult sexual assault victims. Posttraumatic stress disorder numbing symptoms directly predicted revictimization, whereas other post-traumatic stress disorder symptoms (reexperiencing, avoidance, and arousal) were related to problem drinking, which in turn predicted revictimization. Thus, numbing symptoms and problem drinking may be independent risk factors for sexual revictimization in adult sexual assault victims, particularly for women with a history of childhood sexual abuse.

Sexual and physical revictimization among victims of severe childhood sexual abuse

OBJECTIVE

This 15-year prospective, longitudinal study examines adolescent and young-adult female self-reports of traumatic sexual and physical experiences occurring subsequent to substantiated childhood sexual abuse-revictimizations (N=89).

METHOD

These incidences were contrasted to sexual and physical victimizations reported by a group of non-abused comparison females (N=90).

RESULTS

Abused females were almost twice as likely to have experienced sexual revictimization (odds=1.99+/-2.79, p<.05), and physical revictimization (odds=1.96+/-2.58, p<.05) as compared to victimization rates reported by comparison females. Abused females' revictimizations were also more likely to have been perpetrated by older, non-peers and characterized by physical injury than were victimizations reported by comparison females.

CONCLUSION

Early childhood sexual abuse may provide information regarding the level of risk for recurrent sexual and physical victimization.

Substance use and PTSD symptoms impact the likelihood of rape and revictimization in college women

The present study utilized a mixed retrospective and prospective design with an 8-month follow-up period to test a model of revictimization that included multiple childhood (i.e., child sexual, physical, and emotional abuse) and situational variables (i.e., substance use, sexual behavior) for predicting rape among 276 college women. It was of particular interest to determine whether traumatic responses (e.g., posttraumatic symptomatology or risky behavior) increased vulnerability for revictimization. During the 8-month follow-up period, 9% of participants were raped; 88% of assaults involved substance use by the victim. Posttraumatic stress disorder (PTSD) symptomatology predicted rape, substance use, and sexual behavior. Substance use, but not sexual behavior, mediated the relation between PTSD symptomatology and rape during the follow-up period. Sexual behavior indirectly impacted risk for rape via substance use. Results suggest that college women with PTSD symptomatology may be at greater risk for rape if they use substances to reduce distress.

Effects of multiple maltreatment experiences among psychiatrically hospitalized youth

OBJECTIVE

Relying on indicators coded from information collected routinely during intake assessments at a secure inpatient psychiatric facility, this study examined the extent to which different forms of maltreatment accounted for variations in youths' emotional and behavioral problems.

METHODS

Clinical information was reviewed for a large (N=401) and diverse sample (mean age=13.9 years; 53% male; 54.6% racial/ethnic minority) of youth admitted to a publicly funded psychiatric hospital. Data were drawn from intake narratives, standardized psychopathology rating scales, and psychiatric diagnostic ratings.

RESULTS

Findings provide some support for a hierarchical classification of multiple maltreatment experiences with sexual abuse identified as the specific form of maltreatment most reliably associated with poor adjustment. Support also was obtained for a cumulative classification approach, as the number of different types of maltreatment experiences was linked positively to elevated psychopathology ratings.

CONCLUSIONS

Even in this high-risk, atypical sample, maltreatment experiences account for variation in levels of psychopathology. These results have implications for classifying multiple maltreatment and enhancing clinical care for atypical youth who have been maltreated.

PRACTICE IMPLICATIONS

Clinicians working in youth psychiatric populations should implement maltreatment-specific psychotherapy approaches for maltreated youth, even as adjunctive treatments in a therapeutic milieu.

ORIGINAL RESERACH—OUTCOMES ASSESSMENT: How Reliable is a Self-administered Questionnaire in Detecting Sexual Abuse: A Retrospective Study in Patients with Pelvic-Floor Complaints and a Review of Literature

INTRODUCTION

Sexual abuse and sexual functioning are topics that health professionals find difficult to discuss. Women who present with pelvic-floor complaints often experience sexual difficulties; therefore, questions regarding sexual function should be a routine part of screening. Furthermore, pelvic-floor complaints are correlated with sexual abuse and asking about abuse should be a routine part of screening as well. Considering the fact that many practitioners have difficulty enquiring about abuse, we have suggested that a questionnaire may be helpful in improving the recognition and management of patients who have a history of sexual abuse.

AIM

The efficiency of detecting sexual abuse by a self-administered questionnaire.

METHODS

Report of sexual abuse in a self-administered pelvic-floor questionnaire before visiting our outpatient pelvic-floor department was evaluated with the Pelvic Floor Leiden Inventories (PelFIs) administered by a pelvic- floor clinician in a later stage.

MAIN OUTCOME MEASURES

The percentage of sexual abuse detected by a taken questionnaire administered by a pelvic-floor clinician not confessed during a previous self-administered questionnaire.

RESULTS

Sexual abuse was reported in 20 patients with pelvic-floor dysfunction during administration of the PelFIs and were also evaluated on our pelvic-floor department. Only six of the patients (30%) did not note in the self-administered questionnaire that they had a history of sexual abuse.

CONCLUSION

A self-administered questionnaire for pelvic-floor complaints is reliable in detecting sexual abuse and can be helpful in daily practice.

Attachment style, home-leaving age and behavioral problems among residential care children

In a prospective study, the attachment style, home-leaving age, length of time in residential care, and behavioral problems among Israeli residential care children (N = 68), were studied. Data analyses showed that children removed from their homes at a later age suffered from higher levels of anxiety, depression and social problems compared to children taken from their homes at the age of 7 or less. It was also found that a prolonged stay (over 2 years) in residential care was related to higher levels of anxiety and depression. An interaction effect of a child's attachment style and home-leaving age was found in the child's level of aggressive behavior.

Prevalence and predictors of dating violence among adolescent female victims of child sexual abuse

The purpose of this study was to advance knowledge of dating violence behaviors among adolescent victims of child sexual abuse (CSA), first, by determining the prevalence of psychological and physical dating violence and the reciprocity of violence, and second, by investigating the influence of certain CSA characteristics to dating violence. Respondents included 126 females ages 13 to 17 years. More than 45% reported experiencing some sort of physical violence in their dating relationships. Psychological violence was reciprocal in more than 90% of the cases. Multiple regression analysis revealed a significant contribution of CSA characteristics. Multiple regression analyses revealed that the duration of the sexual abuse and the presence of violence or completed intercourse during the abuse could significantly contribute to dating violence above and beyond other known risk factors. Discussion underscores the need to gain a better understanding of CSA and other risk factors that might influence violent dating behaviors.

Sexual revictimization: the role of sexual self-esteem and dysfunctional sexual behaviors

Disproportionately high rates of sexual revictimization have been noted among former victims of child sexual abuse (CSA), yet researchers have yet to determine the source of this apparent vulnerability to reexperience sexual violence. This study explores this issue by examining sexual self-esteem, sexual concerns, and sexual behaviors among 402 university women. Compared to women without a history of CSA (n = 348), women with a history of CSA (n = 54) had lower sexual self-esteem, poorer sexual adjustment, and were 2 times more likely to have experienced sexual assault since the age of 14 years. Structural equation modeling indicated that the relationship between child abuse (i.e., CSA and child psychological maltreatment) and sexual revictimization was partially mediated by sexual self-esteem, sexual concerns, and high-risk sexual behaviors. This study emphasizes the need for further research on child maltreatment, revictimization, and women's sexual adjustment.

Mental health treatments and associated factors amongst mid-aged Melbourne women

The aim of this study was to describe lifetime treatment rate and the treatment modalities used for psychiatric problems and to identify variables associated with the history of psychiatric treatment among mid-aged Melbourne women.A longitudinal observational study was carried out using a population-based sample of 438 mid-aged women interviewed annually for eight years. The baseline data on sociodemographic profiles and premenstrual symptoms, and history of exposure to violence obtained at year 6 were included in this analysis. All other variables including psychiatric treatment history, psychosocial and lifestyle variables, chronic medical conditions and mood score were obtained at year 8. We found 22.2% of the women in this study had ever taken psychotropic medication. Antidepressants were the most used drugs. History of hospitalization for psychiatric problems was reported by 15 women (3.9%). 27 of 387 women (7%) reported they had received other types of treatment for psychiatric problems such as counseling or psychotherapy. Of all variables taken from the questionnaire about the treatment, only the history of psychotropic medication had a high enough frequency for regression analysis. History of psychotropic drug use was associated with interpersonal stresses, poor self-rated health, and prior history of depressive change during the premenstrual period. Socio-demographic variables, exposure to violence, lifestyle factors, and chronic physical conditions were not associated with psychotropic drug use.

Spousal Abuse Against Women and Its Consequences on Reproductive Health: A Study in the Urban Slums in Bangladesh

OBJECTIVES

Spousal violence is common and results in costly problems both for society and for the reproductive health of women. Despite the recognition that violence may be associated with serious consequences for women's reproductive health, our understanding of the relationship between the two remains limited. In this study, we assessed the association between spousal violence and women's reproductive health.

METHODS

Data from an interviewer-administered questionnaire assessing socioeconomic, demographic, behavioral profiles, and spousal violence-related information was collected from 496 women. Subjects were chosen from eight randomly selected urban slums from four metropolitan cities.

RESULTS

Spousal violence was significantly higher amongst the group of less educated women who had been in several marriages; indicating that the social and behavioral traits of women act as catalysts for spousal violence. Abusive husbands also had been married several times and were more likely to be addicted to alcohol or drugs. This demonstrates that the behavioral traits of husbands were also responsible for spousal violence. Spousal violence injuries adversely affect the health and well-being of women. More than three-quarters of physically violated women suffered injuries as a result of this violence. About 50% of these injuries were minor and about 10% serious. Sexual violence adversely affected women's health; more than 80% of sexually violated women complained of pelvic pain, more than 50% reported reproductive tract infections, and more than 50% reported symptoms of irritable bowel syndrome. Abused women suffered from gynecological problems at the time of pregnancy significantly more than non-abused women (p<0.05) and abused women suffered from reproductive tract infections significantly more than non-abused women (p<0.01). Abusive husbands suffered from sexually transmitted diseases (STD) significantly more than non-abusive husbands (p<0.05). Abused women used contraception significantly less than non-abused women (p<0.01). Logistic regression analysis suggested that spousal violence was the most important contributing factor for reproductive health problems in women.

CONCLUSIONS

The findings of this study may enhance our understanding of the impact of spousal violence against women and their reproductive health and therefore highlight the importance of spousal violence prevention measures. Increasing the awareness and understanding of the relationship between violence against women and reproductive health could be achieved if lawyers, researchers, clinicians, practitioners, and government workers from multiple disciplines and agencies worked together.

Use of sexual intercourse to reduce negative affect as a prospective mediator of sexual revictimization

Increased risk of adult sexual assault (ASA) among women who experienced child sexual abuse (CSA) is well established. The strategies these women use to reduce negative affect secondary to CSA, such as sexual contact, may mediate the link between CSA and later ASA. Two waves of data from a racially diverse sample (i.e., 46% Black, 46.1% White, 7.9% other) of community women (N = 776) were analyzed using structural equation modeling. A history of CSA was associated with a twofold increase in the likelihood of experiencing ASA between the two measurement occasions (approximately 6 years). Psychological distress (i.e., depression, anxiety) and use of sex to reduce negative affect partially mediated the relation between CSA and prospective ASA. Implications for the treatment of CSA and prevention of sexual assault are discussed.

Differences in psychological health and family dysfunction by sexual victimization type in a clinical sample of African American adolescent women

We examined levels of sexual victimization among a sample of 249 14- to 19-year-old African American adolescent women. Victimization was common: 32.1% reported having been raped, 33.7% had experienced sexual coercion, and 10.8% reported an attempted rape. Only 23.4% had never been victimized. We investigated whether levels of psychological health and family dysfunction varied as a function of the type of sexual victimization. Girls who had been raped had lower levels of self-esteem and mastery and higher levels of depression compared to girls who reported no sexual victimization. Significantly higher levels of family cohesion and significantly lower levels of family support were reported by girls who had been raped versus girls who reported no sexual victimization. These findings are a starting point for future studies by providing evidence that levels of mental health and family dysfunction vary by the type of sexual victimization experienced.

Sexual revictimization: a review of the empirical literature

This article reviews the literature on sexual revictimization, covering approximately 90 empirical studies and includes a discussion of prevalence, risk factors, and correlates of sexual revictimization. Research suggests that two of three individuals who are sexually victimized will be revictimized. The occurrence of childhood sexual abuse and its severity are the best documented and researched predictors of sexual revictimization. Multiple traumas, especially childhood physical abuse, and recency of sexual victimization are also associated with higher risk. There is preliminary evidence that membership in some ethnic groups or coming from a dysfunctional family places an individual at a greater risk. Revictimization is associated with higher distress and certain psychiatric disorders. People who were revictimized show difficulty in interpersonal relationships, coping, self-representations, and affect regulation and exhibit greater self-blame and shame. Existing research on prevention efforts and treatment is discussed. More longitudinal studies on sexual revictimization are needed.

Perceived Uncontrollability and Unpredictability, Self-Regulation, and Sexual Revictimization

This article reviews the descriptive literature on sexual revictimization and the evidence for the theoretical models that have been formulated to explain this phenomenon. Also, a speculative account of sexual revictimization is presented. The proposed model emphasizes individuals’ attempts to influence or control the quality, frequency, intensity, or duration of fear and arousal associated with a history of uncontrollable and unpredictable childhood sexual abuse through the use of antecedent or response-focused emotion regulation processes. The various forms of emotion regulation may produce symptoms or behaviors that may signal vulnerability to sexual predators, result in impairment of the ability to properly process danger cues, and impede successful defensive behavior. Implications of the proposed model and future directions are discussed.

The role of disclosing child sexual abuse on adolescent adjustment and revictimization

The role of disclosing child sexual abuse on adolescent survivors' symptomatology and the presence of additional unwanted sexual experiences was investigated in a subsample of 111 adolescents from the National Survey of Adolescents who reported child sexual abuse. Results indicated that prompt disclosure of sexual abuse to an adult moderated the influence of penetration during the abuse on the number of symptoms at assessment. Thus, prompt disclosure buffered the influence of more severe abuse. Disclosure also had a main effect on the likelihood of further victimization. Participants who told an adult promptly after the abuse were less likely to report additional unwanted sexual experiences.

Descrição de um processo terapêutico em grupo para adolescentes vítimas de abuso sexual

Pessoas que sofreram abuso sexual na infância ou adolescência carregam seqüelas emocionais provenientes do abuso, em diferentes graus. Este estudo teve como objetivo geral a análise de um processo terapêutico em grupo desenvolvido com adolescentes do sexo feminino, vítimas de abuso sexual intrafamiliar, visando diminuir seqüelas do abuso e melhorar seu repertório de enfrentamento. O processo de quinze sessões foi dividido em quatro fases, com objetivos específicos: (I) Preparação - dessensibilizar para facilitar a auto-exposição; (II) Revelação e exposição de sentimentos - facilitar a revelação do abuso sexual; (III) Aceitação - discutir a aceitação do abuso sexual e seu lugar na história de vida da pessoa; e (IV) Prevenção - facilitar a aprendizagem de comportamentos de autoproteção que impeçam a revitimização. Os resultados mostraram que exposições graduais ao tema feitas em grupo podem facilitar a revelação, a expressão de sentimentos e a aceitação do abuso na história de vida das participantes.

Revictimization and self-harm in females who experienced childhood sexual abuse: results from a prospective study

Lifetime trauma histories were ascertained for females with confirmed histories of childhood sexual abuse and comparison females participating in a longitudinal, prospective study. Abused participants reported twice as many subsequent rapes or sexual assaults (p = .07), 1.6 times as many physical affronts including domestic violence (p = .01), almost four times as many incidences of self-inflicted harm (p = .002), and more than 20% more subsequent, significant lifetime traumas (p = .04) than did comparison participants. Sexual revictimization was positively correlated with posttraumatic stress disorder symptoms (PTSD), peritraumatic dissociation, and sexual preoccupation. Physical revictimization was positively correlated with PTSD symptoms, pathological dissociation, and sexually permissive attitudes. Self-harm was positively correlated with both peritraumatic and pathological dissociation. Competing theoretical explanations for revictimization and self-harm are discussed and evaluated.