A meta-analysis of the published research on the effects of child sexual abuse

Annual Research Review: Mapping the multifaceted approaches and impacts of adverse childhood experiences - an umbrella review of meta-analyses

Adverse childhood experiences (ACEs) significantly impact lifelong health and well-being. Despite extensive research, a comprehensive understanding of ACEs' multifaceted impacts continues to be challenging to achieve. This study synthesizes meta-analytic evidence to provide a comprehensive view of ACEs' effects, addressing various approaches to conceptualizing ACEs and their diverse outcomes. Employing an umbrella synthesis methodology, this review integrated findings from 99 meta-analyses involving 592 effect sizes. We examined ACEs through specificity, lumping, dimensional, and child maltreatment-centric approaches, assessing their impact across six domains: biological system dysregulation, neuropsychological impairments, physical health complications, mental health conditions, social and behavioral challenges, and criminal justice involvement. The findings reveal a small to moderate overall effect size of ACEs across outcome domains. Specific ACE approaches exhibited varying impact levels, with notable differences in effects on mental health, social/behavioral issues, and criminal justice involvement. When ACEs were aggregated without distinguishing between different types, but with consideration of their cumulative effects, adverse outcomes were significantly exacerbated. The child maltreatment-centric approach consistently demonstrated substantial effects across all evaluated domains. This review underscores the heterogeneity in ACEs' impacts, influenced by the type of ACE and specific outcomes considered. It highlights the necessity for comprehensive approaches to understanding, preventing, and mitigating the effects of ACEs. These insights are vital for developing targeted interventions and informing policy-making, emphasizing the complexity and varied nature of ACEs' influence on individual development and societal well-being.

(Un)safe Spaces: The Relationship Between Slavery and Sexual Victimization of Black Women

Research exploring the correlates of sexual victimization has found sexual victimization to be associated with both individual- and contextual-level factors, including age, gender, poverty, and size of the female population. However, to date, research has been limited in exploring how historical factors, such as slavery, may be associated with the contemporary prevalence of sexual victimization of women. Historical accounts have often suggested that enslaved women often experienced sexual victimization during their enslavement. Despite these accounts, research has been limited in empirically exploring the relationship between slavery and the sexual victimization of Black women. Using the 1860 U.S. Census and the 2019 National Incidence-Based Reporting System, multilevel logistic regression analyses are employed to explore whether slavery is consequential for contemporary instances of Black female sexual victimization. In line with the "legacy effect" framework, the findings from the current study suggest that Black women are significantly more likely to be sexually victimized in counties characterized by larger enslaved populations in 1860. These findings illuminate how historical institutions, despite being outlawed, have contemporary consequences, particularly for Black women. These findings, discussions, avenues for future research, and policy implications are discussed below.

Acceptance of a Web-Based Intervention in Individuals Who Committed Sexual Offenses Against Children: Cross-Sectional Study

BACKGROUND

Individuals who have committed sexual offenses against children often have difficulties finding treatment, despite its potential effectiveness. Although the development of web-based interventions could enhance therapeutic supply, up to now the acceptance thereof among this target group is unknown.

OBJECTIVE

For the first time, this study assesses the acceptance of a web-based intervention among individuals who committed sexual offenses against children and analyzes variables that predict acceptance. Following the Unified Theory of Acceptance and Use of Technology (UTAUT), it is assumed that acceptance of web-based interventions in individuals who have committed sexual offenses against children follows the same mechanisms as for individuals in general psychiatry.

METHODS

This cross-sectional study is based on the data from an ongoing clinical trial (@myTabu) evaluating the effectiveness of a web-based intervention in individuals who committed sexual offenses against children (N=113). Acceptance level was measured using a questionnaire based on the UTAUT and modified for the target group. Furthermore, predictors of acceptance from the UTAUT (performance expectancy, effort expectancy, and social influence [SI]), attitudes toward web-based interventions, and internet anxiety were assessed at baseline.

RESULTS

Most participants (61.1%, 69/113), reported high acceptance, while 36.3% (41/113) of them indicated moderate acceptance, and 2.7% (3/113) of them expressed low acceptance. In a linear regression model, the predictors explained 41.2% of the variance (F11,101=9.055; P=.01). Attitudes toward web-based interventions (B=0.398, 95% CI 0.16-0.64; P=.001) and SI (B=0.183, 95% CI 0.03-0.38; P=.04) significantly predicted acceptance. Post hoc explorative analysis showed that the participants' belief that people close to them would recommend the use of a web-based intervention is a predictor of acceptance. In contrast, the belief that their community supervisor would recommend the use thereof was not predictive in this respect.

CONCLUSIONS

For the participants of this study, we identified high acceptance of web-based interventions for the majority of participants. SI and the participants' attitudes toward web-based interventions were important in predicting acceptance.

TRIAL REGISTRATION

German Clinical Trial Registration (DRKS, Deutsches Register Klinischer Studien) DRKS 00021256; https://drks.de/search/de/trial/DRKS00021256.

It's More Than a Matter of Trust: What Parents and Young Children Need to Know to Prevent Intrafamilial Child Sexual Abuse

Programs aimed at preventing child sexual abuse typically focus on skilling up young children and, to a lesser extent, parents by imparting a range of protective messages. Many sexual abuse prevention programs include a focus on identifying or vetting "safe" or "trustworthy" people. The authors qualitatively analyzed the content of narratives from individuals with childhood experience of intrafamilial sexual abuse, an under-represented voice in the development of child sexual abuse prevention programs. The analysis of impediments to protection indicated that, within the family context, reductionistic judgments of familiar individuals' perceived safety or trustworthiness impaired child safety. In addition to adults and children being unable to recognize sexually abusive behavior and warning signs, child-victim survivor narratives highlighted the barriers for prevention in family environments characterized by maltreatment, a lack of child rights or that were unsupported by external authorities. Implications for the content of messages young children and their parents need to prevent child sexual victimization in the context of everyday family life are discussed.

The public's knowledge about child sexual abuse influences its perceptions of prevention and associated policies

BACKGROUND

Child sexual abuse (CSA) prevention requires efforts from all members of society.

OBJECTIVE

The current study aimed to examine factors associated with (1) perceptions of CSA as unpreventable and (2) support for policies to prevent CSA and to punish people who perpetrated CSA. We focused on the roles of knowledge and misperceptions about child sexual abuse.

PARTICIPANTS AND SETTING

We collected survey data online from a large (N = 5068), nationally representative sample of adults in the United States.

RESULTS

Analyses revealed factors promoting perceptions of CSA as unpreventable. Support for or against policies that aim to prevent CSA or to punish perpetrators of CSA were associated with individual factors such as older age (B = 0.08, -0.13), Republican political affiliation (B = 0.10, 0.07), and misperceptions about CSA (B = 0.15, 0.06).

CONCLUSIONS

Findings highlight malleable factors that could be targeted to collectivize calls for CSA prevention and to promote support for effective policies to prevent CSA. In particular, ensuring accurate knowledge about CSA, and collective responsibility and government efficacy specific to CSA prevention, were identified as helping shape views of CSA as preventable.

Emotion regulation and cognitive function as mediating factors for the association between lifetime abuse and risky behaviors in women of color

BACKGROUND

The relationship between lifetime abuse (i.e., childhood abuse, intimate partner violence) and risky behaviors is well established. One proposed mechanism is poor emotion regulation and executive functioning, as a potential mechanism that may explain the relationship between lifetime abuse and risky behaviors. However, research on executive functioning and emotion regulation as mediators of this relationship has been limited. In the present study, we examined this association. We hypothesized that lifetime abuse would be significantly associated with executive function and emotion regulation which in turn would be associated with greater alcohol use and risky sex.

METHODS

This cross-sectional study included 150 women with a history of lifetime abuse who were assessed for hazardous alcohol use using the AUDIT Score; emotion regulation was measured using the Difficulties with Emotion Regulation Scale (DERS); risky sex was measured using the question: "in the last 90 days, how many people did you have anal or vaginal sex without using a condom? Executive function was assessed using the NIH Toolbox.

RESULTS

The mediation model followed the self-regulation theory, which proposes executive function as the higher-order cognitive process. Results showed that executive function deficit and poor emotion regulation significantly mediated the relationship between lifetime abuse and hazardous alcohol use (indirect effect = .097, SE .031, 95% CI = .035 to .158).

CONCLUSION

Our findings suggest a higher-order cognitive process with executive function promoting emotion regulation as a potential mechanism for alcohol problems in women of color who experienced lifetime abuse.

Community trauma exposure and post-traumatic stress disorder in Chinese children and adolescents

Background

An increasing number of studies have shown the association between traumatic events occurring in childhood and adolescence and post-traumatic stress disorder (PTSD). A gap remains in the literature on the epidemiology and influencing factors of traumatic events and post-traumatic stress disorder in communities in northern China. This study aimed to determine the prevalence of traumatic events and PTSD in communities in northern China, to explore the types of stressful traumatic events and the impact of these traumatic events on children and adolescents, and to investigate the effect of sociodemographic factors on PTSD.

Methods

A cross-sectional survey study was conducted among 6,027 students (7-17 years old) from 6 cities in Liaoning Province, China. The sample consisted of 2,853 males (47.34%) and 3,174 females (52.66%). The Essen Trauma-Inventory for Children and Adolescents (ETI-CA) Scale was used. The ETI-CA has 5 sections, which include type of traumatic events, worst traumatic event, post-traumatic symptoms, onset, duration, burden of PTSD, and present difficulties in different areas of life. PTSD symptoms were assessed with 23 items in Part 3 of the ETI-CA.

Results

We found that 2,068 (34.3%) of 6,027 participants experienced trauma events and 686 (33.2%) of 2,068 reported PTSD. Among trauma-exposed youth (2,068), the sudden death of close relatives (33.9%), serious accidents (20.9%), and parental divorce (15.5%) were reported as the worst traumatic events. Studies have shown that after exposure to stressful life events, more than 30% of people feel nervous or upset (39.8%), scared (33.4%), helpless (32.6%), and about 10% have headaches (15.5%), rapid heartbeat (13.3%), and dizziness (11.8%). Multivariable logistic regression analyses showed that students in middle school [OR = 1.29 (1.016, 1.637)], not a student leader [OR = 0.738 (0.618, 0.881)], and their parents in single marital status significantly predicted higher PTSD prevalence the remarried [OR = 0.474 (0.252, 0.893)], married [OR = 0.42 (0.227, 0.778)].

Conclusion

The present study suggests the government to train psychological counselors in schools and communities to provide emotional and psychological support, as well as the school leaders and parents to elevate adolescents' psychological suzhi. Particularly, counseling and professional support should be given to those students whose parents are single.

Prior Sexual Trauma Exposure Impacts Posttraumatic Dysfunction and Neural Circuitry Following a Recent Traumatic Event in the AURORA Study

Background

Prior sexual trauma (ST) is associated with greater risk for posttraumatic stress disorder after a subsequent traumatic event; however, the underlying neurobiological mechanisms remain opaque. We investigated longitudinal posttraumatic dysfunction and amygdala functional dynamics following admission to an emergency department for new primarily nonsexual trauma in participants with and without previous ST.

Methods

Participants (N = 2178) were recruited following acute trauma exposure (primarily motor vehicle collision). A subset (n = 242) completed magnetic resonance imaging that included a fearful faces task and a resting-state scan 2 weeks after the trauma. We investigated associations between prior ST and several dimensions of posttraumatic symptoms over 6 months. We further assessed amygdala activation and connectivity differences between groups with or without prior ST.

Results

Prior ST was associated with greater posttraumatic depression (F1,1120 = 28.35, p = 1.22 × 10-7, ηp2 = 0.06), anxiety (F1,1113 = 17.43, p = 3.21 × 10-5, ηp2 = 0.05), and posttraumatic stress disorder (F1,1027 = 11.34, p = 7.85 × 10-4, ηp2 = 0.04) severity and more maladaptive beliefs about pain (F1,1113 = 8.51, p = .004, ηp2 = 0.02) but was not related to amygdala reactivity to fearful versus neutral faces (all ps > .05). A secondary analysis revealed an interaction between ST and lifetime trauma load on the left amygdala to visual cortex connectivity (peak Z value: -4.41, corrected p < .02).

Conclusions

Findings suggest that prior ST is associated with heightened posttraumatic dysfunction following a new trauma exposure but not increased amygdala activity. In addition, ST may interact with lifetime trauma load to alter neural circuitry in visual processing regions following acute trauma exposure. Further research should probe the relationship between trauma type and visual circuitry in the acute aftermath of trauma.

Therapeutic Dance for the Healing of Sexual Trauma: A Systematic Review

Therapeutic dance has been increasingly used as a treatment modality for sexual trauma, yet its evidence-based efficacy has not yet been catalogued. We therefore conducted a systematic review to summarize the existing evidence for therapeutic dance as an intervention for healing after sexual trauma. We searched 5 major databases to identify intervention studies on the use of therapeutic dance for individuals with histories of sexual trauma. Studies were included based on the following criteria: 1) the study involves individuals who have been exposed to sexual trauma; 2) the study reports on any form of dance as a therapeutic intervention; and 3) the study reports on dance intervention outcomes. A total of 1,686 sources were identified. Of these, 11 articles met eligibility criteria and were assessed. Reported outcomes were extracted and organized into emergent domains. We found that therapeutic dance acts upon three broad domains-affect, self, and interpersonal relationships - and can be delivered in diverse settings. Across the studies, dance showed benefits on outcomes. However, a significant weakness of the current peer-reviewed literature is the lack of robust empirical intervention research on dance therapy. Overall, the emerging literature suggests that therapeutic dance is a potential intervention for those who have experienced sexual trauma. The review findings presented here can be used to inform practitioners and systems of care targeted for those who have been subject to sexual trauma.

Women's strategies for navigating a healthy sex life post-sexual trauma

Sexual trauma is common. Consequences of sexual trauma can include deterioration of mental and physical health and it can also affect future romantic and sexual relationships. Previous studies have identified common healthy and destructive coping mechanisms to recover after experiencing sexual trauma, but few studies have investigated useful strategies to move into a healthy sexual relationship focused on resilience. In-depth semi-structured interviews were conducted with 41 women with a history of sexual trauma who were in a healthy sexual relationship at the time of participation. Participants provided strategies that helped them move beyond the sexually traumatic event(s) toward a healthy sexual relationship. Reflexive thematic analysis identified 5 effective and 6 ineffective strategies reported by the participants. Rich examples of resilience and empowerment were overarching in the effective strategies used for moving toward healthy sexual relationships. Women were also able to reflect on the strategies that were ineffective for them with kindness and understanding for their coping at that time, a normalizing theme for women working through sexual trauma. The results of this study will help therapists and researchers working with women who have experienced sexual trauma learn from their experiences in working beyond trauma toward a healthy sexual relationship.

Cumulative childhood trauma, sex motives and sexual satisfaction among emerging adults

BACKGROUND

To better understand sexual satisfaction in emerging adults, previous research has emphasized the importance of considering the role of developmental experiences, such as cumulative childhood trauma (CCT; the number of different forms of abuse and neglect sustained during childhood). However, the mechanisms by which CCT and sexual satisfaction are related remain unknown. Sex motives are suggested as an explanatory mechanism given the previously found associations between sex motives and both sexual satisfaction and CCT.

OBJECTIVE

This study examined the direct associations between CCT and sexual satisfaction, as well as indirect associations through sex motives, in emerging adults.

PARTICIPANTS AND SETTING

A sample of 437 French Canadian emerging adults (76 % women, mean age of 2.3) were recruited.

METHODS

Participants completed online self-reported validated questionnaires assessing CCT, sex motives and sexual satisfaction.

RESULTS

Results from a path analysis revealed that CCT was associated with a higher endorsement of the self-affirmation sex motive (β = 0.25, p < .001) which was linked to lower sexual satisfaction (β = -0.13, p < .001). CCT was also associated with a higher endorsement of the coping (β = 0.25, p < .001) and partner approval (β = 0.09, p < .05) sex motives. A higher endorsement of the intimacy (β = 0.28, p < .001) and pleasure (β = 0.24, p < .001) sex motives, and a lower endorsement of the partner approval sex motive (β =  -0.13, p < .001) were linked to greater sexual satisfaction.

CONCLUSIONS

Results suggest education and intervention targets to improve emerging adults' sexuality.

Psychological symptoms of adolescent survivors of sexual abuse and characteristics of survivors displaying suicidal and/or self-harming behaviors

We examine the psychological symptoms and suicide attempts and/or self-injury behaviors of survivors of childhood sexual abuse (CSA) according to individual and familial characteristics. The participants of this study included 80 adolescents aged 14-17 years. We show that high psychological symptom scores may indicate that the perpetrator was a family member and that penetration occurred. In addition, most of the participating survivors have experienced numerous problems, largely related to psychological symptoms. Considering the results regarding survivors who had previously attempted suicide, we demonstrate that the perpetrators in these cases were mostly reliable/loved people, while these survivors generally hid the events and were exposed to penetration more often. We conclude that survivors exposed to CSA by a reliable/loved person, blaming themselves, having low social support, and displaying certain symptoms should be followed closely and necessary psychosocial interventions for suicide should be applied.

Comparing female- to male-perpetrated child sexual abuse as presumed by survivors - A qualitative content analysis

BACKGROUND

Female-perpetrated child sexual abuse (CSA) is taboo topic in society and an under-recognized issue in research and mental health care.

OBJECTIVE

The aim of the present study was to examine perspectives of individuals surviving female-perpetrated CSA (in parts in addition with male-perpetrated CSA) on the question whether female-perpetrated CSA and its sequelae were considered different compared to male-perpetrated CSA.

PARTICIPANTS AND SETTING

The perspectives of 212 survivors of female-perpetrated CSA were captured in a cross-sectional online study.

METHODS

Answers to the questions "How does female-perpetrated CSA differ from male-perpetrated CSA?" and "How do consequences of female-perpetrated CSA differ from those of male-perpetrated CSA?" were analyzed using qualitative content analysis.

RESULTS

The analyses reveal ten categories of differences, such as a more subtle approach, different levels of violence, and more psychological manipulation. Further, the analyses suggest ten categories of different personal consequences, such as less belief and support, more psychological sequelae, and disturbed relationships with women.

CONCLUSIONS

Approaches to raise awareness about gender stereotypes in the context of CSA are needed and special needs of survivors of female-perpetrated CSA in psychotherapeutic treatment can be derived from the results of this study.

Physical and sexual victimization of persons with severe mental illness seeking care in central and southwestern Uganda

Purpose

This study established the prevalence of physical and sexual victimization, associated factors and psychosocial consequences of victimization among 1,201 out-patients with severe mental illness at Butabika and Masaka hospitals in Uganda.

Methods

Participants completed structured, standardized and locally translated instruments. Physical and sexual victimization was assessed using the modified adverse life events module of the European Para-suicide Interview Schedule. We used logistic regression to determine the association between victimization, the associated factors and psychosocial consequences.

Results

The prevalence of physical abuse was 34.1% and that of sexual victimization was 21.9%. The age group of > = 50 years (aOR 1.02;95% CI 0.62-1.66; p = 0.048) was more likely to have suffered physical victimization, while living in a rural area was protective against physical (aOR 0.59; 95% CI 0.46-0.76; p = <0.001) and sexual (aOR 0.48, 95% CI 0.35-0.65; p < 0.001) victimization. High socioeconomic status (SES) (aOR 0.56; 95% CI 0.34-0.92; p = <0.001) was protective against physical victimization. Females were more likely to have been sexually victimized (aOR 3.38; 95% CI 2.47-4.64; p = <0.001), while being a Muslim (aOR 0.60; 95% CI 0.39-0.90; p = 0.045) was protective against sexual victimization. Risky sexual behavior was a negative outcome associated with physical (aOR 2.19; 95% CI 1.66-2.90; p = <0.001) and sexual (aOR 3.09; 95% CI 2.25-4.23; p < 0.001) victimization. Mental health stigma was a negative outcome associated with physical (aOR 1.03; 95% CI 1.01-1.05; p < 0.001) and sexual (aOR 1.03; 95% CI 1.01-1.05; p = 0.002) victimization. Poor adherence to oral anti-psychotic medications was a negative outcome associated with physical (aOR 1.51; 95% CI 1.13-2.00; p = 0.006) and sexual (aOR 1.39; 95% CI 0.99-1.94; p = 0.044) victimization.

Conclusion

There is a high burden of physical and sexual victimization among people with SMI in central Uganda. There is need to put in place and evaluate complex interventions for improving detection and response to abusive experiences within mental health services. Public health practitioners, policymakers, and legislators should act to protect the health and rights of people with SMI in resource poor settings.

A Meta-Analysis of the Effects of Childhood Maltreatment on Elderly Depression

Background: The present study aimed to synthesize the effects of five types of child maltreatment (physical abuse, emotional abuse, sexual abuse, physical neglect and emotional neglect) on late-life depression.Method: Four English-language databases (Web of Science, PsycINFO and PsycARTICLES, PubMed, and Cochrane Library) and three Chinese databases (China National Knowledge Infrastructure, Wanfang Database, and Weipu Database) were systematically reviewed, and data related to the association between child maltreatment and late-life depression were extracted. Ten studies involving 30,308 older adults were included, and the effect sizes were pooled using random-effect models.Findings: Except for sexual abuse, four types of child maltreatment were found to be positively associated with late-life depression. Physical abuse, emotional abuse and physical neglect were associated with elderly depression (PA: OR = 1.73, 95% CI = 1.55-1.95, p < .001; EA: OR = 1.92, 95% CI = 1.73-2.12, p < .001; PN: OR = 2.05, 95% CI = 1.15-3.67, p < .01) at a small level, and emotional neglect was associated with elderly depression (OR = 3.25, 95% CI = 1.43-7.39, p < .001) at an approximately moderate level. Gender moderated the relationship between physical neglect, emotional neglect, and late-life depression.Conclusion: Our findings highlight the significance of child maltreatment in the development of late-life depression, and underscore the need for future research and practice to explore potential ways to address late-life depression among older adults who suffered child maltreatment.

Evaluating the Effectiveness of a Live Musical Theater-Based Approach to Child Sexual Abuse Prevention in Elementary Schools

Hugs and Kisses is a theater-based child sexual abuse (CSA) prevention program designed for children in kindergarten through fifth grades. The purpose of this cross-sectional case study is to evaluate how a comprehensive live musical theater program can prepare teachers to discuss and identify the signs of CSA, help children increase their knowledge, and learn prevention strategies to stop CSA in the future. A total of 154 teachers and 2,700 children from 31 schools participated in this program during 2016. Findings show this program increases children's awareness of touch and action knowledge through five primary safety lessons taught during the program and reinforced by a teacher led in-person discussion after the play. Nearly 85% of the students across all grade levels in this sample understood the lessons taught in the play, and students whose teachers held an in-class discussion after the play scored better than those students whose teachers did not hold a discussion. Teachers who were prepared with training resources also held longer in-class discussions compared to those who were not prepared. The Hugs play has the potential to be a national model for evidence-based CSA programs.

Systematic review exploring the relationship between sexual abuse and lower urinary tract symptoms

INTRODUCTION AND HYPOTHESIS

Patients presenting with lower urinary tract symptoms (LUTS) may report a history of sexual abuse (SA), and survivors of SA may report LUTS; however, the nature of the relationship is poorly understood. The aim of this review is to systematically evaluate studies that explore LUT dysfunction in survivors of SA.

METHODS

A systematic literature search of six databases, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, was performed. The last search date was June 2021 (PROSPERO CRD42019122080). Studies reporting the prevalence and symptoms of LUTS in patients who have experienced SA were included. The literature was appraised according to the PRISMA statement. The quality of the studies was assessed.

RESULTS

Out of 272 papers retrieved, 18 publications met the inclusion criteria: studies exploring LUTS in SA survivors (n=2), SA in patients attending clinics for their LUTs (n=8), and cross-sectional studies (n=8). SA prevalence ranged between 1.3% and 49.6%. A history of SA was associated with psychosocial stressors, depression, and anxiety. LUTS included urinary storage symptoms, voiding difficulties, voluntary holding of urine and urinary tract infections. Most studies were of moderate quality. Assessment of SA and LUTS lacked standardisation.

CONCLUSIONS

The review highlights the need for a holistic assessment of patients presenting with LUTS. Although most of the studies were rated as being of 'moderate' quality, the evidence suggests the need to provide a "safe space" in clinic for patients to share sensitive information about trauma. Any such disclosure should be followed up with further assessment.

Interrupting the intergenerational cycle of violence: protocol for a three-generational longitudinal mixed-methods study in South Africa (INTERRUPT_VIOLENCE)

BACKGROUND

Violence is a global social and human rights issue with serious public health implications across the life-course. Interpersonal violence is transmitted across generations and there is an urgent need to understand the mechanisms of this transmission to identify and inform interventions and policies for prevention and response. We lack an evidence-base for understanding the underlying mechanisms of the intra- and intergenerational transmission of violence as well as potential for intervention, particularly in regions with high rates of interpersonal violence such as sub-Saharan Africa. The study has three aims: 1) to identify mechanisms of violence transmission across generations and by gender through quantitative and qualitative methods; 2) to examine the effect of multiple violence experience on health outcomes, victimisation and perpetration; 3) to investigate the effect of structural risk factors on violence transmission; and 4) to examine protective interventions and policies to reduce violence and improve health outcomes.

METHODS

INTERRUPT_VIOLENCE is a mixed-methods three-generational longitudinal study. It builds on a two-wave existing cohort study of 1665 adolescents in South Africa interviewed in 2010/11 and 2011/12. For wave three and possible future waves, the original participants (now young adults), their oldest child (aged 6+), and their former primary caregiver will be recruited. Quantitative surveys will be carried out followed by qualitative in-depth interviews with a subset of 30 survey families. Adults will provide informed consent, while children will be invited to assent following adult consent for child participation. Stringent distress and referral protocols will be in place for the study. Triangulation will be used to deepen interpretation of findings. Qualitative data will be analysed thematically, quantitative data using advanced longitudinal modelling. Ethical approval was granted by the University of Edinburgh, University of the Witwatersrand, North-West University, and the Provincial Department of Health Mpumalanga. Results will be published in peer-reviewed journals, policy briefs, and at scientific meetings.

DISCUSSION

The proposed study represents a major scientific advance in understanding the transmission and prevention of violence and associated health outcomes and will impact a critically important societal and public health challenge of our time.

Clinical Stakes of Sexual Abuse in Adolescent Psychiatry

BACKGROUND

The extent and nature of sexual abuse (SA) and its consequences in psychiatry are still poorly described in adolescence.

OBJECTIVE

This article describes the frequency of SA reported in an adolescent population hospitalized in psychiatry, and assesses its links with the severity of mental disorders and the medical issues of these adolescents.

METHODS

The study includes 100 patients for whom SA has been mentioned, among all patients aged 13 to 17 years old hospitalized for about 4 years. The characteristics of sexual abuse were correlated with the medical severity of the patients, as well as the number, the duration of their hospitalization(s), and the time until disclosure.

RESULTS

The results show the central place of SA in adolescent psychiatry, with a prevalence of 28.5% and a cumulative hospital stay which is five times longer than average. Correlations have been observed between the number of suicide attempts and the number of abuses reported. The medical severity of patients is significantly increased when the named aggressor is an adult. The number of hospitalizations is positively correlated with the number of reported abuses, as well as with the intrafamilial and adult status of the perpetrator. Finally, an early age of onset, repeated abuse, and the intrafamilial nature of the abuse are associated with a longer time to disclosure.

CONCLUSIONS

The severity of adolescent psychiatric situation is statistically in favor of a history of SA, which should therefore be actively explored during care.

Association of Dissociation with Suicide Attempt and Non-Suicidal Self Injury in Adolescents with a History of Sexual Abuse

Objective: Dissociative symptoms are considered risk factors for suicide and non-suicidal self-injury (NSSI). In this study, the relationship between suicidal behaviors and NSSI with dissociative symptoms in adolescents with a history of Child Sexual Abuse (CSA) was investigated. Methods: A total of 100 adolescents with a history of CSA were evaluated with a detailed forensic psychiatric interview. Dissociative symptoms were measured with the self-report Adolescent Dissociative Experiences Scale (A-DES) and the parent-reported Child Dissociative Checklist (CDC). Results: While dissociative symptoms did not differ between adolescents with and without suicide attempts (CDC; p = .068 and A-DES; p = .060), they were significantly higher in adolescents with non-suicidal self-harming behavior (CDC; p < .001 and A-DES; p = .001). Suicide attempts and NSSI were more common in those who reported genital touching as a type of sexual abuse (respectively, p = .003; p = .048). In regression analysis; history of psychiatric treatment (OR = 9.09 [95% CI = 1.52, 54.29]) and NSSI (OR = 8.18 [95% CI = 2.01, 33.23]) were independently associated with suicide attempts. In addition, parent-reported dissociative symptoms (CDC scores) (OR = 1.27 [95% CI = 1.06, 1.53] and suicide attempt (OR = 8.09 [95%CI = 1.96,33.42] showed independent association with NSSI. Conclusions: Dissociative symptoms may be predictive factors for NSSI and should be considered in risk assessment of adolescents with a history of CSA.

The Longitudinal Effects of Second Step Child Protection Unit on Children: Gender as a Moderator

We investigated the longitudinal effects of the Second Step Child Protection Unit (CPU; Committee for Children) on student outcomes through a randomized controlled trial. Eight schools with a total sample including 2,031 students were assigned randomly to the CPU intervention or the wait-list control condition. We employed a multi-process latent growth model using a structural equation modeling framework which simultaneously analyzed student outcome growth via the effects of the intervention. The moderating effect of gender was also included. Over four data collection waves (pretest, posttest, follow-up [6 months] and follow-up [12-months]), the intervention group students were better able to recognize appropriate requests in CSA scenarios than control group students over time. Teacher-student relations improved for the students in the intervention schools but worsened for the students in the control schools over time. Despite concerns that CSA prevention programs may result in the unintended consequence of making children more fearful, children in both conditions did not show increased fears over time. The longitudinal effect on CSA recognition was more pronounced among girls, who suffer from higher CSA prevalence, compared with boys. Implications for prevention, policy, and directions for future research are discussed.

Myths and Misunderstandings About Child Sexual Abuse in Criminal Investigations

Researchers have established that rape myths shape perceptions of victims and perpetrators in criminal cases. Researchers have devoted less attention to exploring the impact of child sexual abuse (CSA) myths in court. While we know that jurors believe myths and misconceptions about the nature of CSA, no work has explored how these myths appear during the prosecution of CSA cases. The purpose of the present investigation was to assess how defense attorneys apply myths more specific to CSA in the questioning of children testifying about alleged CSA. The present study compliments and expands upon a previous study by St. George and colleagues (2021a), where authors examined the use of rape myths in the questioning of children making allegations of CSA. In the current study, we examined testimonies of 122 children testifying in criminal cases of alleged CSA in the United States. We qualitatively coded 6,384 lines of questioning for references to CSA-focused myths related to the disclosure process, witnesses and privacy issues, assumptions of harm, and the child's positive relationship with the perpetrator. These myths were common, occurring in over 10% of defense attorneys' lines of questioning. Disclosure issues were the most frequent, followed by witness and privacy issues, assumptions of harm, and the child's positive relationship with their perpetrator. In many cases, attorneys employed different strategies across child's age to highlight these myths. These findings compliment those of prior work suggesting that CSA myths, much like rape myths, are appearing with regularity. Defense attorneys are likely capitalizing on jurors' misconceptions to undermine children's believability.

"It was Really Hard for Me to Tell": The Gap between the Child's Difficulty in Disclosing Sexual Abuse, and their Perception of the Disclosure Recipient's Response

Disclosure of child sexual abuse (CSA) is essential to its mitigation and the protection of children. Previous studies have greatly contributed to the understanding of disclosure rates both in childhood and adulthood, in addition to delayed disclosure and disclosure barriers. In acknowledging the relevancy of the ecological framework, researchers have illustrated how the various systems in the children's lives have a role in their decision to disclose the abuse. The current study was designed to delve into the disclosure stories shared by children during their forensic interviews. Fifty children, 30 girls and 20 boys, from diverse communities in the Jewish society in Israel (15 secular, 15 Orthodox and 20 ultra-Orthodox) were forensically interviewed for the first time following CSA. Thematic analysis was carried out on their narratives, focusing on two main themes. The first was the children's descriptions of their difficulties to disclose, which were embedded in their own perceptions and experiences, their fear of the disclosure recipient's response, and their dynamic with the perpetrator. The second theme provided a glance into the children's descriptions of the disclosure recipients' responses, which highlighted the children's central experience of loneliness in the context of the abuse. Theoretical and practical ramifications pertaining to these crucial gaps will be discussed. In addition, specific religious-cultural elements raised in relation to the disclosure will be highlighted. Limitations of the study as well as further recommendations and implications will be introduced.

Childhood Sexual Abuse, Dyadic Empathy, and Intimate Partner Violence Among Men Seeking Psychological Help

Childhood sexual abuse (CSA) and intimate partner violence (IPV) have both been associated with numerous negative repercussions. The first aim of this study is to understand IPV perpetrated by men within a clinical population, by examining the effects of two potential predictors: CSA and dyadic empathy (cognitive and emotional). The second aim of this study is to explore whether dyadic empathy is an intermediary variable of the association between CSA and IPV. A sample of 198 men (aged 18-69 years old) who were seeking help for relationship problems, completed a set of self-administered questionnaires. While controlling for social desirability and family violence history, our findings outlined the mediating and moderating role of dyadic empathy in the link between CSA and perpetrated psychological, but not physical, IPV. Emotional empathy mediated and moderated the link between CSA and psychological IPV, whereas cognitive empathy only moderated this link. The examination of the direct links between the variables also revealed that CSA was related to lower emotional empathy and higher rates of both types of IPV. In addition, cognitive empathy was negatively associated with physical and psychological IPV, whereas emotional empathy was positively associated with psychological IPV. This study contributes to the literature by documenting some of the mechanisms that could explain the perpetration of IPV and highlights the importance of investigating CSA and empathy in men who are seeking help.

[The Effects of the Combined Biofeedback and Brief Emotion Regulation Nursing Intervention Based on the Gross Model for Sexually Abused Adolescents]

PURPOSE

This study aimed to evaluate the effects of a combined biofeedback and brief emotion regulation (C-BABER) program for sexually abused adolescents.

METHODS

This study employed a non-equivalent control group pretest-posttest design. The participants included 26 sexually abused adolescents from eight Sunflower Centers of South Korea-with 13 in the experimental group and 13 in the control group. The experimental group received four sessions of the individual C-BABER program, each lasting 60 minutes.

RESULTS

Compared with the control group, sexually abused adolescents in the experimental group exhibited significant score differences in traumatic symptoms, including depression (Z = -2.24, p = .025), dissociation (Z = -2.21, p = .027), anxiety (Z = -2.02, p = .044), and posttraumatic stress (Z = -2.01 p = .045); and impulsivity, including positive urgency (Z = -3.35, p = .001) and negative urgency (Z = -2.28, p = .023). Additionally, the experimental group exhibited significant score differences in meta-mood, including emotional attention (Z = -2.45, p = .014), emotional clarity (Z = -2.30, p = .021), and emotional repair (Z = -2.28, p = .022); and emotional regulation modes, including emotional suppression (Z = -2.65, p = .008) and cognitive reappraisal (Z = -1.98, p = .047). Regarding bio-attention, significant changes were identified in the experimental group for the bio-attention rate and attention maintenance time in the posttest compared to the pretest (p = .001).

CONCLUSION

The C-BABER program for sexually abused adolescents is effective in decreasing traumatic symptoms and impulsivity, and in improving meta-mood, emotional regulation mode, and bio-attention. Therefore, we recommend providing sexually abused adolescents the C-BABER program to help them regulate their emotions and effectively adapt to their lives.

A Review of Childhood Sexual Abuse Perpetration Prevention Programs

PURPOSE OF REVIEW

The present review examines existing childhood sexual abuse prevention programs that are focused on providing services to individuals who are at risk of perpetration. We describe several perpetrator-oriented prevention programs with evaluation data as well as avenues for future development and research.

RECENT FINDINGS

Perpetration prevention programs can be divided into anonymous and non-anonymous programs. Anonymous programs include those that provide support via helplines and those that provide self-guided digital interventions. Non-anonymous programs provide traditional psychotherapy. There are several prevention programs with limited evaluation data, but no research to date has aggregated these findings and provided a comprehensive assessment of perpetration prevention. There is insufficient evidence to determine whether perpetration prevention programs are effective. More rigorous evaluations of secondary prevention programs are needed. Despite this, early data suggests that perpetration prevention programs are promising.

Pathway to Expectations of Child Functioning Following Sexual Abuse: Caregiver Maltreatment History and Depressive Symptoms

Caregiver responses and behaviors often play a significant role in a child's recovery following child sexual abuse (CSA). Caregiver expectations of their child's postabuse functioning has been associated with child symptoms, such that negative expectations lead to worse outcomes for the child. Additionally, caregivers who experienced maltreatment in their own childhood may face difficulties providing support to their child after CSA. Caregivers' own psychological symptoms may influence their expectations for their child's future functioning following CSA. This study utilized structural equation modeling (SEM) to examine the association between caregivers' childhood maltreatment histories, their expectations for their child's future functioning following CSA, and the indirect effect of caregiver depressive symptoms on this relationship. Participants were 354 nonoffending caregivers presenting to treatment with their child following CSA disclosure. Caregivers were 23-72 years old (M = 38.38, SD = 8.02), predominately white, and predominately biological mothers to the youth who were abused. Results indicated that caregivers who experienced maltreatment in childhood were more likely to experience depressive symptoms, which then lead to more negative expectations of their child's future functioning. As negative expectations are associated with poorer outcomes for children following CSA, increased attention to caregivers' depressive symptoms in treatment may promote more positive expectations for their child's postabuse functioning.

Early Trauma and Later Sexual Victimization in College Women: A Multiple Mediation Examination of Alexithymia, Impulsivity, and Alcohol Use

Childhood abuse and sexual violence against women are prevalent in the United States. However, researchers have not fully explored the intersection among important predisposing factors that predict recent sexual violence experienced by women who are also survivors of childhood abuse. The purpose of this study was to examine the relationships among early childhood trauma, alexithymia, impulsivity, alcohol use severity, and sexual victimization in later life among female college students from the United States (n = 1,178). Participants were part of a larger cross-cultural study, conducted between 2012 to 2014, which examined sexual aggression and victimization in the context of alcohol use. The current study aimed to examine if: (a) early trauma, impulsivity, alexithymia, and alcohol use severity impact sexual victimization in later life, and (b) if impulsivity, alexithymia, and alcohol use severity mediate the relationship between early trauma and victimization in later life. It was hypothesized that impulsivity, alexithymia, and alcohol use severity would significantly mediate the relationship between early trauma and sexual victimization in later life. Using a multiple mediation path analysis, results indicated that early childhood trauma was significantly linked with impulsivity, alcohol use severity, and sexual victimization in later life. A partial mediation through impulsivity and alcohol use severity was observed. Alexithymia did not produce mediation effects. These findings align with previous research examining how early childhood trauma influences the occurrence of sexual victimization in later life and provides further recommendations for helping professionals as they attempt to stifle the sexual victimization rates among female college students.

Addressing the Complexity of Heterogeneity: Profiles of Adolescent Girls Who Have Been Sexually Abused

Childhood sexual abuse (CSA) may have devastating effects, yet, there is considerable heterogeneity among adolescent girls who have experienced it. Addressing this heterogeneity could help to tailor practices to their particular needs. The objective was to identify profiles among adolescent girls who have been sexually abused to determine whether they exhibit distinct outcomes. Participants were drawn from a Child Protection sample of adolescent girls who have been sexually abused with contact (n = 185). Abuse and stressful events were measured using a rating scale completed by a research assistant, and a self-reported questionnaire. Coping strategies, cognitive appraisals, and psychological symptoms were measured using self-reported questionnaires. Latent class analysis was conducted using abuse and stressful events as indicators, and multinomial logistic regression analyses were used to compare classes on outcomes. Five graded classes were identified: 1) few source of stress (22%); 2) services as stressors (27%); 3) CSA as stressor (19%); 4) CSA and family as stressors (6%); and 5) multiple sources of stress (25%). These classes were associated with distinct profiles on coping strategies, cognitive appraisals, and psychological symptoms. In conclusion, we recommend that clinicians move beyond the "one size fits all" approach and tailor practices to each adolescent's needs.

Why Didn't They Intervene? Examining the Role of Guardianship in Preventing Institutional Child Sexual Abuse

In recent years, the failings of institutions to safeguard children from sexual abuse have been brought to light through investigations and commissions of inquiries such as Australia's Royal Commission into Institutional Responses to Child Sexual Abuse. The role of adults as guardians, to protect children within these institutions, has been afforded particular scrutiny, highlighting past ineffective and harmful intervention and responses to abuse, and even inaction. Despite this attention, limited research to date has explored the barriers underpinning guardianship behavior in this setting. Enhanced understanding of the potential barriers to guardianship is key for informing improved guardianship behavior in the future. Using data from Australia's Royal Commission, this study applies Reynald's (2010) model of capable guardianship to investigate dimensions of guardianship in youth-serving institutional settings. Three discrete settings were examined: outside school hours care, schools, and sporting institutions. Results support the utility of Reynald's (2010) model for advancing knowledge about guardianship behavior in youth-serving institutions, providing valuable lessons for future policy directions, to enhance safeguarding practices.

Childhood Sexual Abuse, Spirituality/Religion, Anxiety and Depression in a Jewish Community Sample: the Mediating Role of Religious Coping

Childhood sexual abuse (CSA) is a pervasive problem impacting a broad range of mental health outcomes. Previous research has shown that spiritual and religious (S/R) factors both positively and negatively relate to mental health issues among survivors of CSA, but mediating mechanisms of effect are unclear. The present study examined CSA, anxiety, depression, and positive/negative religious coping among 372 Jewish community members with and without CSA histories. Individuals who experienced CSA endorsed significantly higher anxiety and depression as well as negative religious coping than those without CSA. Negative religious coping mediated the relationship between CSA and anxiety and depression. We discuss clinical and social implications of these findings, including the need to address S/R factors in treatment of CSA, especially within religious communities. Further research examining abuser identity, survivors' disclosure experience, and other S/R mediators of effect is warranted.

Child protection training for professionals to improve reporting of child abuse and neglect

BACKGROUND

Many nations require child-serving professionals to report known or suspected cases of significant child abuse and neglect to statutory child protection or safeguarding authorities. Considered globally, there are millions of professionals who fulfil these roles, and many more who will do so in future. Ensuring they are trained in reporting child abuse and neglect is a key priority for nations and organisations if efforts to address violence against children are to succeed.

OBJECTIVES

To assess the effectiveness of training aimed at improving reporting of child abuse and neglect by professionals and to investigate possible components of effective training interventions.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 18 other databases, and one trials register up to 4 June 2021. We also handsearched reference lists, selected journals, and websites, and circulated a request for studies to researchers via an email discussion list.

SELECTION CRITERIA

All randomised controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies examining the effects of training interventions for qualified professionals (e.g. teachers, childcare professionals, doctors, nurses, and mental health professionals) to improve reporting of child abuse and neglect, compared with no training, waitlist control, or alternative training (not related to child abuse and neglect).

DATA COLLECTION AND ANALYSIS

We used methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We synthesised training effects in meta-analysis where possible and summarised findings for primary outcomes (number of reported cases of child abuse and neglect, quality of reported cases, adverse events) and secondary outcomes (knowledge, skills, and attitudes towards the reporting duty). We used the GRADE approach to rate the certainty of the evidence.

MAIN RESULTS

We included 11 trials (1484 participants), using data from 9 of the 11 trials in quantitative synthesis. Trials took place in high-income countries, including the USA, Canada, and the Netherlands, with qualified professionals. In 8 of the 11 trials, interventions were delivered in face-to-face workshops or seminars, and in 3 trials interventions were delivered as self-paced e-learning modules. Interventions were developed by experts and delivered by specialist facilitators, content area experts, or interdisciplinary teams. Only 3 of the 11 included studies were conducted in the past 10 years. Primary outcomes Three studies measured the number of cases of child abuse and neglect via participants' self-report of actual cases reported, three months after training. The results of one study (42 participants) favoured the intervention over waitlist, but the evidence is very uncertain (standardised mean difference (SMD) 0.81, 95% confidence interval (CI) 0.18 to 1.43; very low-certainty evidence). Three studies measured the number of cases of child abuse and neglect via participants' responses to hypothetical case vignettes immediately after training. A meta-analysis of two studies (87 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.81, 95% CI 1.30 to 2.32; very low-certainty evidence).  We identified no studies that measured the number of cases of child abuse and neglect via official records of reports made to child protection authorities, or adverse effects of training. Secondary outcomes Four studies measured professionals' knowledge of reporting duty, processes, and procedures postintervention. The results of one study (744 participants) may favour the intervention over waitlist for training (SMD 1.06, 95% CI 0.90 to 1.21; low-certainty evidence). Four studies measured professionals' knowledge of core concepts in all forms of child abuse and neglect postintervention. A meta-analysis of two studies (154 participants) favoured training over no training, but the evidence is very uncertain (SMD 0.68, 95% CI 0.35 to 1.01; very low-certainty evidence). Three studies measured professionals' knowledge of core concepts in child sexual abuse postintervention. A meta-analysis of these three studies (238 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.44, 95% CI 0.43 to 2.45; very low-certainty evidence). One study (25 participants) measured professionals' skill in distinguishing reportable and non-reportable cases postintervention. The results favoured the intervention over no training, but the evidence is very uncertain (SMD 0.94, 95% CI 0.11 to 1.77; very low-certainty evidence). Two studies measured professionals' attitudes towards the duty to report child abuse and neglect postintervention. The results of one study (741 participants) favoured the intervention over waitlist, but the evidence is very uncertain (SMD 0.61, 95% CI 0.47 to 0.76; very low-certainty evidence).

AUTHORS' CONCLUSIONS

The studies included in this review suggest there may be evidence of improvements in training outcomes for professionals exposed to training compared with those who are not exposed. However, the evidence is very uncertain. We rated the certainty of evidence as low to very low, downgrading due to study design and reporting limitations. Our findings rest on a small number of largely older studies, confined to single professional groups. Whether similar effects would be seen for a wider range of professionals remains unknown. Considering the many professional groups with reporting duties, we strongly recommend further research to assess the effectiveness of training interventions, with a wider range of child-serving professionals. There is a need for larger trials that use appropriate methods for group allocation, and statistical methods to account for the delivery of training to professionals in workplace groups.

How to Treat Childhood Sexual Abuse Related PTSD Accompanied by Risky Sexual Behavior: A Case Study on the Use of Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD)

Childhood and adolescent sexual abuse (CSA) is a traumatic experience associated with a variety of short- and long-term negative consequences. Theoretical models assume that an abuse related and learned distorted image of sexuality might lead CSA survivors to feel obligated to provide sex or engage in unwanted sexual practices in order to gain affection or prevent abandonment. Dialectical behavioral therapy for posttraumatic stress disorder (DBT-PTSD) is tailored to people with PTSD and comorbid emotion regulation deficits. This case study presents the results of an outpatient DBT-PTSD treatment of an adult patient with posttraumatic stress disorder following sexual and physical abuse. DBT-PTSD was used to treat the patient's complex psychopathological problems and to decrease her risky sexual behavior, which manifested itself in highly dangerous sexual practices with her partner. The treatment took place over a period of 18 months, with a total of 72 sessions. At the end of the treatment, the patient no longer met criteria for PTSD as indicated by large reductions in the assessments used. Furthermore, she managed to distance herself from risky sexual practices and to remain in a satisfying relationship.

Childhood Sexual Abuse and Coping as Young Adults: The Roles of Attachment and Mattering

This study examined whether a history of childhood sexual abuse (CSA), attachment to mother, father, and friends, and mattering were related to the coping behaviors of 171 male and 85 female, ethnically diverse, low-income, young adults. The 74 survivors of CSA reported lower attachment to father and less mattering to parents than did the 97 who reported no abuse. Compared to male survivors, female survivors reported greater use of problem-focused coping and also perceived their abuse experience, particularly the use of force, as having a more negative impact on them. Stronger attachment to mother and to friends predicted more positive problem-focused coping. Mattering to friends moderated the relation between CSA history and problem-focused coping, with the CSA survivors who reported the highest mattering to friends also using the most problem-focused coping strategies. The role of attachment and mattering in problem-focused coping among young adults, especially those with a CSA history, is discussed.

Child Sexual Abuse and Problems Reported by Survivors of CSA: A Meta-Review

A systematic meta-review of reviews and meta-analyses on problems reported by survivors of Child Sexual Abuse (CSA) was conducted. The aim was to comprise a comprehensive overview of 1) problems reported by survivors of CSA, and 2) variables moderating these relations. Two raters independently conducted a search through PubMed, PsychINFO, Campbell Library, Cochrane Library and Web of Science. Twenty-five reviews and meta-analyses reporting on 53 problems related to CSA were analyzed. All fell into five domains: medical, psychological, sexual, repeated (self-)harm, and a final category of other problems. Thirty-six of all problems (68%) were consistently and significantly more commonly reported by CSA survivors as compared to individuals without a history of CSA. Most moderator analyses did not significantly influence these relationships. In conclusion, CSA is associated with various problems across different domains and overall, these problems are prevalent independent of specific characteristics of and circumstances surrounding the abuse.

Predicting disclosure latency in substantiated cases of child sexual abuse

OBJECTIVE

Children who experience sexual abuse (CSA) often delay disclosure, thus impeding early interventions. This study explores predictors of disclosure latency in a sample of forensically substantiated cases.

METHODS

Court files were analyzed for a total of 124 cases of CSA. The ground truth of the alleged victims' statements had been substantiated by at least one inclusion criterion-an evaluation of the alleged victims' statement as credible by psychological experts applying Statement Validity Assessment (SVA), or the conviction of the suspected offender by the court. Six possible predictors of disclosure latency were tested individually and in a joint negative binomial regression model.

RESULTS

Younger age of the child at abuse onset and intrafamilial (vs. extrafamilial) child-perpetrator relationships (including stepparents) were associated with prolonged disclosure latency. No predictive evidence was found for the child's gender, severity of abuse, or offender's usage of violent or nonphysical strategies to prevent disclosure.

CONCLUSION

This study contributes to understanding the processes of disclosure by reassessing formerly identified predictors of disclosure latency in a sample of forensically substantiated cases. Results are in line with suggestions to further develop effective prevention programs for younger children (e.g., for elementary school) and to explicitly discuss the issue of intrafamilial abuse.

Current of Child Sexual Abuse in Asia: A Systematic Review of Prevalence, Impact, Age of First Exposure, Perpetrators, and Place of Offence

BACKGROUND: Child sexual abuse (CSA) is a serious global problem and challenge for all people because it increases the risk of various issues. AIM: This study investigated the CSA in Asian countries focusing on prevalence rates, impact, victim’s age of first exposure, type of CSA, perpetrator, and places of CSA offence. METHODS: We searched PubMed, Medline, ProQuest, ScienceDirect, CINAHL, Academic Search Complete, ClinicalKey, PsycINFO, Google Scholar, and manual search for studies published between January 2011 and November 2020. Only articles related to CSA in Asia were included in this review. RESULTS: The results showed that prevalence of CSA ranged from 2.2% - 94% for girls and 1.7% - 49.5% for boys. The prevalence rates for non-contact abuse were 12.6% - 56.5% for girls and 0.7% - 68.7% for boys; contact abuse was 5.3% - 67.2% for girls and 2.2% - 53.3% for boys; penetrating abuse was 0.5% - 88.24% for girls and 1.7% - 57.1% for boys. The findings reported most victims’ age of first exposure was preteen. The rate of the violation occurring in the victim’s house was 6.1% - 41.9%; most CSA perpetrators are known by victims. This study reported adverse impacts on CSA victims such as psychological, health, and physical disorders, and changes in behavior. In addition, other findings were found, including recovery, perceptions, values, causes, and expectations of victims of CSA. CONCLUSIONS: The incidence of CSA in Asia is still high and the age of the first victims is early adolescence. The majority of victims are women who already know the perpetrator, and taboo cultural factors are thought to play a role in increasing CSA in Asia. The results indicate the need to develop CSA prevention efforts that involve culture.

A latent class analysis of physical, emotional, and sexual abuse history among suicidal inpatients

OBJECTIVE

Physical, emotional, and sexual abuse are subtypes of childhood abuse that may persist into adulthood. This study applied latent class analysis to describe the pattern of co-occurrence of these three abuse subtypes during childhood and adulthood and examined latent class differences in psychosocial characteristics and three types of suicide attempt history (aborted, interrupted, and actual).

METHODS

Data were drawn from a high-risk sample of 115 military service members and adult beneficiaries who were psychiatrically hospitalized following a suicide-related crisis.

RESULTS

Three latent classes were identified: Multiple and Persistent Abuse (Class One: 29.6%), Childhood Physical and Persistent Emotional Abuse (Class Two: 27.0%), and Minimal Abuse (Class Three: 43.5%). Females were more likely than males to report a history of Multiple and Persistent Abuse. After controlling for gender, the Multiple and Persistent Abuse Class had higher scores of depressive symptoms and hazardous drinking, poorer sleep quality, and increased social stress than the Minimal Abuse Class. Moreover, the Multiple and Persistent Abuse Class was associated with increased likelihood of lifetime interrupted suicide attempt (Odds Ratio [OR] = 3.81, 95% CI = 1.20, 12.07) and actual suicide attempt (OR = 3.65, 95% CI = 1.23, 10.85), and had the greatest number of total actual suicide attempt (1.82 times on average).

CONCLUSION

Co-occurrence of multiple subtypes of abuse across development is associated with higher psychosocial risk and history of suicide attempt. The assessment of specific subtypes of abuse and their timing may inform case conceptualization and the management of suicide risk among psychiatric inpatients.

Teacher-Student Sexual Relationships: The Role of Age, Gender, and Multiple Victims on Incarceration and Registration Outcomes

Minimal research has examined sentencing outcomes in teacher-student sexual abuse cases, while the research that has been conducted has primarily focused on gender and attractiveness. Furthermore, the body of literature examining how gender affects sentencing has contradictory findings. Age of the victim and number of victims may also play a role in sentencing outcomes. The current study aimed to better understand which factors (by examining how gender of the victim and defendant, age of the victim and defendant, and having multiple victims) are associated with sentencing outcomes in cases where teachers engage in inappropriate sexual relationships with students. The sentencing outcomes that were assessed include length of incarceration, likelihood of having to register as a sexual offender, and likelihood of being incarcerated. The current study reviewed 250 cases that were covered in the media between 2008 and 2010 that involved a defendant who was accused of sexual contact with a student whom they had contact with through their role as an educator or school staff member. Results indicate that defendant age, victim age, and whether there was one or multiple victims had significant implications for sentencing outcomes. An increase in victim age was associated with a decreased likelihood of incarceration, shorter incarceration lengths, and a decreased likelihood to be required to register as a sexual offender. An increase in defendant age was also associated with increased likelihood of incarceration. Furthermore, having multiple victims was associated with increased incarceration lengths. This study has implications for school policies and teacher training specific to building appropriate relationships and boundaries with students. Given the rise in reporting of sexual abuse cases between teachers and their students, implementing more comprehensive ethics training is paramount.

Posttraumatic stress disorder symptoms moderate the relation between childhood sexual abuse and disordered eating in a community sample

OBJECTIVE

Previous work has found clear associations between childhood sexual abuse (CSA) and disordered eating in adulthood. However, further research is needed to clarify factors that may influence this relationship. The current study advanced existing research by examining the moderating influence of posttraumatic stress disorder (PTSD) symptom severity in the association between CSA and disordered eating.

METHOD

Data were collected from 463 individuals with a history of sexual assault or other unwanted sexual experience(s) (M_age  = 34.71, 54.9% women, 77.5% white) who were recruited from MTurk.

RESULTS

Results indicated significant positive relations among CSA, PTSD symptom severity, and disordered eating. CSA was found to be associated with disordered eating at high, but not low, levels of PTSD symptom severity.

DISCUSSION

This study highlights the importance of assessing disordered eating and PTSD symptoms in individuals who report a history of CSA. Clinicians aiming to reduce their patients' symptoms of disordered eating may benefit from considering the potential role of PTSD symptom severity as a barrier to achieving treatment gains.

Overall and Gender-specific Associations between Dimensions of Adverse Childhood Experiences and Mental Health Outcomes among Homeless Adults: Associations Générales et Sexospécifiques Entre les Dimensions des Expériences Défavorables de L'enfance et les Résultats de Santé Mentale Chez les Adultes Sans Abri

OBJECTIVE

The associations between adverse childhood experiences (ACEs) and psychopathology have been well-established in the general population. Research on ACEs in the homeless population has been limited. This study examined whether ACE exposure is associated with specific mental health outcomes among a national sample of homeless adults with mental illness and whether this association varies according to ACE dimension and gender.

METHODS

This cross-sectional study utilized data from a national sample of 2,235 homeless adults with mental illness in Canada to evaluate their sociodemographic characteristics, exposure to ACEs, and mental health outcomes. Exploratory and confirmatory factor analyses were conducted to identify and confirm ACE dimensions (maltreatment, sexual abuse, neglect, divorce, and household dysfunction) from individual ACE items. Multivariable logistic regression was used to examine the associations between total ACE score and ACE dimensions with mental illness diagnoses and psychopathology severity.

RESULTS

The mean total ACE score among all study participants was 4.44 (standard deviation [SD]: 2.99). Total ACE score was positively associated with several mental illness diagnoses and psychopathology severity. Unique associations were found between specific ACE dimensions and poor mental health outcomes. The prevalence of almost all ACEs was significantly higher among women. Yet, associations between several ACE dimensions and poor mental health outcomes existed uniquely among men.

CONCLUSIONS

There are unique and gender-specific associations between specific ACE dimensions and mental health outcomes among homeless adults. Better understanding of the mechanisms underlying these associations is needed to inform screening, prevention, and treatment efforts, particularly given the very high prevalence of ACEs among this vulnerable and marginalized population.

The impact of childhood sexual abuse and adverse childhood experiences on adult health related quality of life

BACKGROUND

Adverse childhood experiences (ACEs) have been shown to be associated with adult physical, psychological, and socioeconomic well-being, indicative of poor health-related quality of life (HRQoL). However, the association between child sexual abuse (CSA) and adult HRQoL, independent of other ACEs, has been less well examined.

OBJECTIVES

To examine associations between self-reported CSA, including the nature of CSA, and adult HRQoL.

PARTICIPANTS

Data are from 10,624 respondents to CSA and HRQoL questions on the 2015 Texas Behavioral Risk Factor Surveillance System survey.

METHODS

Analyses included chi square and t-tests to compare sociodemographic and HRQoL differences among those with and without history of CSA. Multivariable logistic regressions were used to evaluate associations between nature of CSA and HRQoL, controlling for covariates.

RESULTS

The prevalence of self-reported CSA in the sample was 10.3%. Compared to the non-exposed group, individuals exposed to CSA were more likely to report their general health as poor (AOR, 1.51; 95% CI, 1.09-2.09), report 14 or more physical unhealthy days (AOR, 1.46; 95% CI, 1.06-2.02), 14 or more mental unhealthy days (AOR, 1.86; 95% CI, 1.30-2.64), and 14 or more activity limitation days (AOR, 2.22; 95% CI, 1.58-3.10) in a month. HRQoL outcomes were worse for respondents who reported being forced to have sex as a child compared with those who reported being touched or forced to touch someone.

CONCLUSIONS

Self-reported CSA is associated with lower HRQoL. The association varies by the nature of reported sexual abuse. Understanding the long-term impacts of CSA can inform adult treatment options and policies to prevent and treat CSA.

Childhood adversity links to self-reported mood, anxiety, and stress-related disorders

BACKGROUND

Child abuse has been identified within the DSM-5 as a putative etiologic risk for over two dozen psychiatric disorders.

METHODS

This study examined associations between self-reported diagnostic histories of six Mood, Anxiety and Stress-Related Disorders and childhood adversities measured using dichotomous ACE (Adverse Childhood Experiences) counts and dimensional indices of child abuse.

RESULTS

Adversity odds ratio were all significant (p < .001) and averaged as follows: sexual abuse, OR_M = 3.16; emotional abuse, OR_M = 2.62; physical abuse, OR_M = 2.41; maternal battering, OR_M = 2.15. An effort was made to differentiate between additive and interactive adversity risks. While significant adversity interactions were found, they tended to be modest in effect sizes and scope. The combination of sexual, physical and emotional abuse was associated with a maximal odds ratio and prevalence for Major Depression (OR = 5.13, 70.8%). The large impacts of unitary adversities limited the potential for large interactive effects.

LIMITATIONS

The cross-sectional analysis relied on retrospective self-reports that may not generalize fully to respondents differing in ethnicity, religion, sexual orientation, or other factors.

CONCLUSIONS

Childhood adversity in four different forms was associated with higher prevalence rates for six different mood and anxiety disorders. Childhood sexual and emotional abuse appeared to account for unshared variance in all of these lifetime diagnoses. Significant high risk adversity combinations were found for Major Depression (sexual/physical/ emotional), Post-Traumatic Stress Disorder (sexual/physical & physical/maternal battering), and Generalized Anxiety Disorder (physical/emotion/maternal battering).

Vaginismus, Dyspareunia and Abuse History: A Systematic Review and Meta-analysis

BACKGROUND

Genito-pelvic pain/penetration disorder, which consists of a combination of vaginismus and dyspareunia, is considered a new diagnosis in the latest version of the Diagnostic and Statistical Manual of Mental Disorders. Although the etiology of this diagnosis is not well known, a history of abuse has been suggested to be a primary factor in the emergence of this disorder.

AIM

This systematic review and meta-analysis aimed to determine the association of abuse history with vaginismus and dyspareunia diagnosis.

METHODS

Related keywords were used to search articles in PubMed, PsycArticles, PsycINFO, Scopus, Web of Science, and the Turkish scientific information database (TRDizin). All articles published in English and Turkish until August 2020 were systematically reviewed. A total of 14 case-control studies, including 1428 participants, were included in the final analysis. The fixed-effects model was used to pool odd ratios (ORs) and 95% confidence intervals (CIs) of the studies. Heterogeneity was evaluated using the I² statistic.

OUTCOMES

Case-control studies that reported vaginismus or dyspareunia outcomes in individuals with or without a history of abuse.

RESULTS

A significant relationship was found between a history of sexual (1.55 OR; 95% CI, 1.14-2.10; 12 studies) and emotional abuse (1.89 OR; 95% CI, 1.24-2.88; 3 studies) and the diagnosis of vaginismus. A significant relationship was found between sexual abuse and dyspareunia (1.53 OR; 95% CI, 1.03-2.27; 6 studies). No statistically significant relationship was observed between physical abuse, vaginismus, and dyspareunia. No significant difference was found between sexual or physical abuse in terms of assessment methods for the diagnosis of vaginismus and dyspareunia.

CLINICAL IMPLICATIONS

This systematic review and meta-analysis points out that in the assessment of vaginismus patients, the risk of sexual and emotional abuse and in the assessment for dyspareunia patients, the risk of sexual abuse should be questioned and addressed in its treatment.

STRENGHT AND LIMITATIONS

The strength of the current meta-analysis is the inclusion of all forms of abuse, and studies published in Turkish and English with a broad and reproducible search strategy. The limitations of this meta-analysis are the exclusion of sources and design other than journal articles and case-control studies, including studies both childhood and adult abuse, which in some studies were not differentiated, having potential language and recall bias.

CONCLUSION

The study analysis suggests an association of vaginismus with sexual and emotional abuse and dyspareunia with sexual abuse. However, both disorders showed no association with physical abuse. S. Tetik, ÖY. Alkar, Vaginismus, Dyspareunia, and Abuse History: A Systematic Review and Meta-analysis. J Sex Med 2021;18:1555-1570.

Impulsivity and the effects of alcohol in women with a history of childhood sexual abuse: A pilot study

Women with a history of childhood sexual abuse (CSA) are at greater risk to develop alcohol use disorders. Whereas impulsivity has been postulated as a behavioral mechanism linking childhood trauma and alcohol use, few studies have comprehensively examined impulsivity in women with CSA. We compared women with a history of CSA (n = 21) and control women who did not endorse CSA or other major traumas (CON; n = 21) on self-report measures of impulsivity and risk taking. Additionally, performance on behavioral impulsivity and subjective response to alcohol were examined before and after acute alcohol (0.00, 0.50, 0.75 g/kg) administration. Overall, women with CSA responded more impulsively than CON women on the immediate and delayed-memory tasks (measures of response initiation) and the GoStop task (a measure of response inhibition). Whereas alcohol produced dose-related increases in impulsive responding on the immediate memory task in both groups, alcohol-induced increases in response inhibition on the GoStop task were evident only in the CSA group. In contrast, women with CSA exhibited less risk taking than the CON group on the balloon analogue risk task. Alcohol produced dose-related increases on several subjective response measures (e.g., alcohol liking) in both groups; however, these ratings tended to be greater in women with CSA. These preliminary data suggest that women with CSA may be more impulsive. Importantly, impulsivity can lead to hazardous drinking, and alcohol consumption can further increase impulsivity, putting women with CSA at increased risk for sexual revictimization, particularly in the context of alcohol use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Die Entwicklung von Sexualität bei Kindern und Jugendlichen mit sexuellen Gewalterfahrungen

Zusammenfassung. Theoretischer Hintergrund: Zu den Folgen sexueller Gewalt gehören neben somatischen und psychischen Folgen auch Veränderungen in der Entwicklung der Sexualität. Fragestellung: Ziel dieses Reviews ist es, einen systematischen Überblick über den aktuellen Forschungsstand bezüglich der Entwicklung von Sexualität bei Kindern und Jugendlichen nach sexuellen Gewalterfahrungen zu geben. Methode: Eine systematische Literaturrecherche wurde in den Datenbanken PubMed, ERIC, Cochrane und PubPsych durchgeführt. Die Folgen von sexueller Gewalt bezüglich der Sexualität wurden systematisch analysiert. Ergebnisse: Es konnten insgesamt 127 Studien zur Sexualität nach sexueller Gewalt identifiziert werden, die acht Unterkategorien zugeordnet werden konnten: Sexuelles Risikoverhalten, Teenagerschwangerschaft, jugendliche Sexualstraftäter_innen, sexuelle Verhaltensauffälligkeiten, sexuelle Überzeugungen, Prostitution, Geschlechtskrankheiten und körperliche Symptome. Diskussion und Schlussfolgerung: Insgesamt zeigt die Literaturrecherche, dass die Sexualität von Kindern und Jugendlichen mit sexuellen Gewalterfahrungen teilweise nur lückenhaft untersucht wurde.

Associations of premorbid adjustment with type and timing of childhood trauma in first-episode schizophrenia spectrum disorders

Background

Childhood trauma may contribute to poorer premorbid social and academic adjustment which may be a risk factor for schizophrenia.

Aim

We explored the relationship between premorbid adjustment and childhood trauma, timing of childhood trauma's moderating role as well as the association of clinical and treatment-related confounders with premorbid adjustment.

Setting

We conducted a secondary analysis in 111 patients with first-episode schizophrenia (FES) disorders that formed part of two parent studies, EONKCS study (n =73) and the Shared Roots study (n =38).

Methods

Type of childhood trauma was assessed with the Childhood Trauma Questionnaire, short-form and premorbid adjustment using the Premorbid Adjustment Scale. Timing of childhood trauma was assessed using the Life Events Checklist and life events timeline. Linear regression analyses were used to assess the moderating effect of timing of childhood trauma. Clinical and treatment-related confounders were entered into sequential hierarchical regression models to identify independent predictors of premorbid adjustment across key life stages.

Results

Childhood physical neglect was associated with poorer premorbid academic functioning during childhood and early adolescence, and poorer premorbid social functioning during early and late adolescence. By hierarchical regression modelling (r ² = 0.13), higher physical neglect subscale scores (p = 0.011) independently predicted poorer premorbid social adjustment during early adolescence. Timing of childhood trauma did not moderate the relationship between childhood trauma and premorbid functioning.

Conclusion

In patients with FES, childhood physical neglect may contribute to poorer premorbid social functioning during early adolescence. This may provide us with an opportunity to identify and treat at-risk individuals earlier.

Sexual harassment and assault predict sleep disturbances and is partly mediated by nightmares: Findings from a national survey of all university students in Norway

Sexual harassment and assault is common in most domains of society, and has been linked to several adverse outcomes, including reduced sleep quality. However, less is known about the possible impact of sexual harassment and assault on various sleep problems among university students. In a sample of 49,051 students in Norway (69.2% women), we examined i) the associations of varying extents of sexual harassment (unwanted sexual comments, looks or gestures, photographs, indecent exposure, and physical harassment) and sexual assault (attempted or completed rape), with meeting Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic criteria of insomnia and with sleep duration, ii) the association of cumulative exposure to sexual harassment/assault with insomnia and sleep duration, and iii) to what extent nightmares could explain the association between sexual harassment and insomnia and sleep duration. For both genders, all forms of harassments with the exception of "indecent exposure" and "unwanted sexual photographs" for men were negatively associated with sleep duration, with the strongest associations being found for "rape" and "attempted rape". For both genders, the odds of insomnia increased as a function of cumulative harassment exposure. Similarly, a graded, negative association was found between cumulative harassment and sleep duration for both genders. Mediation analyses showed that 28% of the observed association between cumulative harassment and insomnia, and 15% of the association between cumulative harassment and sleep duration, was mediated by frequency of nightmares.