Significance, Nature, and Direction of the Association Between Child Sexual Abuse and Conduct Disorder: A Systematic Review

Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment

Importance

The proportion of mental disorders and burden causally attributable to childhood maltreatment is unknown.

Objective

To determine the contribution of child maltreatment to mental health conditions in Australia, accounting for genetic and environmental confounding.

Design, Setting, and Participants

This meta-analysis involved an epidemiological assessment accounting for genetic and environmental confounding between maltreatment and mental health and 3 cross-sectional national surveys: the Australian Child Maltreatment Study (ACMS) 2023, National Study of Mental Health and Well-being 2020-2022, and Australian Burden of Disease Study 2023. Causal estimates were derived on the association between childhood maltreatment and mental health conditions from a meta-analysis of quasi-experimental studies. This was combined with the prevalence of maltreatment from the ACMS to calculate the population attributable fraction (PAF). The PAF was applied to the number and burden of mental health conditions in Australia, sourced from 2 population-based, nationally representative surveys of Australians aged 16 to 85 years, to generate the number and associated burden of mental disorders attributable to child maltreatment.

Exposure

Physical abuse, sexual abuse, emotional abuse, or neglect prior to age 18 years.

Main Outcomes and Measures

Proportion and number of cases, years of life lost, years lived with disability, and disability-adjusted life-years of mental health conditions (anxiety, depression, harmful alcohol and drug use, self-harm, and suicide attempt) attributable to childhood maltreatment.

Results

Meta-analytic estimates were generated from 34 studies and 54 646 participants and applied to prevalence estimates of childhood maltreatment generated from 8503 Australians. Childhood maltreatment accounted for a substantial proportion of mental health conditions, ranging from 21% (95% CI, 13%-28%) for depression to 41% (95% CI, 27%-54%) of suicide attempts. More than 1.8 million cases of depressive, anxiety, and substance use disorders could be prevented if childhood maltreatment was eradicated. Maltreatment accounted for 66 143 years of life lost (95% CI, 43 313-87 314), primarily through suicide, and 184 636 disability-adjusted life-years (95% CI, 109 321-252 887).

Conclusions and Relevance

This study provides the first estimates of the causal contribution of child maltreatment to mental health in Australia. Results highlight the urgency of preventing child maltreatment to reduce the population prevalence and burden of mental disorders.

Internalizing and externalizing problems mediate the relationship between maltreatment and self-harm among UK adolescents

BACKGROUND

Maltreatment is a significant predictive factor for self-harm in adolescents. Internalizing and externalizing problems are both common psychopathological issues in adolescents. This study aimed to look into the link between maltreatment and self-harm in a large sample of adolescents in the UK, as well as the mediating effects that internalizing and externalizing problems play in this link.

METHODS

Data were pulled from the UK Millennium Cohort Study, and a total of 8894 adolescents were included in this analysis. All variables were assessed by Questionnaires. Path analysis was performed to assess the mediating effects of internalizing and externalizing problems in the link between maltreatment and self-harm.

RESULTS

23.4 % of samples reported self-harm incidents during the preceding 12 months. Emotional abuse and physical abuse were significantly related to self-harm, and adolescents who had experienced multiple forms of maltreatment were more prone to self-harm. Mediation analysis revealed that internalizing problems were the primary mediator in the link between emotional abuse and self-harm, with the mediation effect size being 0.29. Internalizing and externalizing problems performed similarly in the link between physical abuse and self-harm, with mediation effect sizes of 0.23 and 0.19, respectively.

LIMITATIONS

The majority of the data was gathered through self-reporting.

CONCLUSIONS

Emotional abuse and physical abuse were significant predictors of self-harm, and their links with self-harm were partially mediated via internalizing and externalizing problems. Better supervision of maltreatment, and timely intervention for both internalizing and externalizing problems, are critical in preventing self-harm among adolescents.

Mental health challenges facing male survivors of child sexual abuse: Implications for mental health nurses

Child sexual abuse (CSA) is an issue of epidemic proportions in the United Kingdom (UK) and an international public health problem. Evidence suggests that in the UK one in 20 children have been sexually abused, with one in three not telling anyone about it at the time of the abuse. Conservative estimates suggest that around one in six men have experienced sexual abuse before the age of 18. CSA has been correlated with the development of numerous mental health problems, abused men often displaying externalizing behaviours, including substance misuse, 'risky' sexual behaviours, anti-social behaviour, and offending. This article reports on one aspect of a research study focusing specifically on male survivors of CSA and its effect on their mental health. Using narrative research, face-to-face interviews were used to collect the stories of four men who participated in the research. Interviews were audio-recorded and transcribed verbatim. Analysis used a two-phase approach; initially, each narrative was analysed as a whole, with an across transcripts analysis then being carried out identifying shared themes emerging from the individual stories. Whilst findings from the second phase of the analysis identify four themes, it is the theme of 'Blocking the Memories' that is the focus for this article. Making a valuable contribution to existent knowledge regarding the experiences of men who were sexually abused as children, this article will help to inform mental health practitioners who are likely to deliver care to male survivors of CSA.

Functional near-infrared spectroscopy is a sensitive marker of neurophysiological deficits on executive function tasks in young adults with a history of child abuse

Previous research has shown the utility of imaging measures of neural activity in identifying deficits in cognitive functioning in individuals with a history of child abuse. The purpose of the present study was to measure differences that may exist between individuals who reported physical, emotional, or sexual abuse as children (n = 37) vs. those who did not (n = 47) using Functional Near Infrared Spectroscopy (fNIRS) during the completion of cognitive tasks of executive function. The results showed a significantly higher rate and number of errors of commission on the Conners CPT test in the child abuse group compared to the control group. The analyses also showed a statistically significant decrease in oxyhemoglobin (oxy-Hb) concentration in the left rostral prefrontal cortex in the child abuse group compared to the no-abuse group during the Wisconsin Card Sorting Test (WCST). A similar, albeit non-significant, trend toward decreased oxy-Hb concentration was observed in the child abuse group in the right dorsolateral prefrontal cortex (dlPFC) on the OSPAN and Connors CPT. The results suggest that the latter group may show subtle neurological deficits that persist into adulthood that may not manifest on traditional measures of cognitive function. These findings have implications for the development of remediation and treatment strategies in this population.

Childhood Maltreatment and Mental Health Problems: A Systematic Review and Meta-Analysis of Quasi-Experimental Studies

OBJECTIVE

Childhood maltreatment is associated with mental health problems, but the extent to which this relationship is causal remains unclear. To strengthen causal inference, the authors conducted a systematic review and meta-analysis of quasi-experimental studies examining the relationship between childhood maltreatment and mental health problems.

METHODS

A search of PubMed, PsycINFO, and Embase was conducted for peer-reviewed, English-language articles from database inception until January 1, 2022. Studies were included if they examined the association between childhood maltreatment and mental health problems using a quasi-experimental method (e.g., twin/sibling differences design, children of twins design, adoption design, fixed-effects design, random-intercept cross-lagged panel model, natural experiment, propensity score matching, or inverse probability weighting).

RESULTS

Thirty-four quasi-experimental studies were identified, comprising 54,646 independent participants. Before quasi-experimental adjustment for confounding, childhood maltreatment was moderately associated with mental health problems (Cohen's d=0.56, 95% CI=0.41, 0.71). After quasi-experimental adjustment, a small association between childhood maltreatment and mental health problems remained (Cohen's d=0.31, 95% CI=0.24, 0.37). This adjusted association between childhood maltreatment and mental health was consistent across different quasi-experimental methods, and generalized across different psychiatric disorders.

CONCLUSIONS

These findings are consistent with a small, causal contribution of childhood maltreatment to mental health problems. Furthermore, the findings suggest that part of the overall risk of mental health problems in individuals exposed to maltreatment is due to wider genetic and environmental risk factors. Therefore, preventing childhood maltreatment and addressing wider psychiatric risk factors in individuals exposed to maltreatment could help to prevent psychopathology.

Does Conduct, Oppositional Defiant, and Panic Disorder Symptoms Associate with Suicidal Ideations Among African American Adolescents?

Previous studies suggest that mental illness symptoms among adolescents, such as conduct disorder, oppositional defiant disorder, and panic disorder symptoms often associate with suicidal ideations. Despite this, few studies have examined whether these mental illness symptoms associate with suicidal ideations among African American adolescents. To address these limitations, the current study examined whether conduct disorder, oppositional defiant disorder, and panic disorder symptoms associated with suicidal ideations (N = 261). Using binominal logistic regression, results suggest that conduct disorder symptoms were associated with a higher likelihood of endorsing suicidal ideations than oppositional defiant disorder symptoms. Finally, panic disorder symptoms and gender differences were not associated with suicidal ideations. Preventive efforts and psychotherapy implications are discussed.

Trauma-focused therapies for post-traumatic stress in psychosis: study protocol for the RE.PROCESS randomized controlled trial

INTRODUCTION

Many people with psychotic disorders experience symptoms of post-traumatic stress disorder (PTSD). In recent years, several trauma-focused therapies (TFTs), including cognitive restructuring (CR), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR) have been studied and found to be safe and effective in reducing PTSD symptoms in individuals with psychosis. However, studies were conducted in different countries, with varying inclusion criteria, therapy duration, control groups, and trial outcomes. RE.PROCESS will be the first study to compare the impact of CR, PE, and EMDR with a waiting list control condition within the same context.

METHODS AND ANALYSIS

This is the protocol of a pragmatic, single-blind, multicentre, superiority randomized controlled trial, in which CR, PE, and EMDR are compared to a waiting list control condition for TFT (WL) in a naturalistic treatment setting. Inclusion criteria are as follows: age ≥ 16 years; meeting full DSM-5 diagnostic criteria for PTSD on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), with a total CAPS score ≥ 23; and a psychotic disorder in the schizophrenia spectrum confirmed by the Structured Clinical Interview for DSM-5 (SCID-5). Participants (N=200) will be randomly allocated to 16 sessions of one of the TFTs or WL, in addition to receiving treatment as usual (TAU) for psychosis. The primary objective is to compare the effects of CR, PE, and EMDR to WL on researcher-rated severity of PTSD symptoms over time from baseline to 6-month follow-up. Secondary objectives are to examine these effects at the separate time-points (i.e., mid-treatment, post-treatment, and at 6-month follow-up) and to test the effects for clinician-rated presence of PTSD diagnosis, and self-rated severity of (complex) PTSD symptoms.

DISCUSSION

This is the first RCT to directly compare the effects of CR, PE, and EMDR within the same context to TAU on PTSD symptoms in individuals with psychosis and PTSD. Secondary effects on clinical and functional outcomes will be investigated both directly after therapy and long term.

TRIAL REGISTRATION

ISRCTN ISRCTN56150327 . Registered 18 June 2019.

Cognitive deficits for facial emotions among male adolescent delinquents with conduct disorder

According to the social-cognitive theory and the social-information-processing theory, individuals with conduct disorder, a persistent and repetitive pattern of problematic behavior, might have cognitive biases toward hostile facial expressions. However, according to the optimal stimulation/arousal theory, the stimulation-seeking theory and the fearlessness theory, individuals with conduct disorder might have less fear and show less response to hostile or threatening facial expressions. To reconcile the discrepancy, we examined the cognitive biases including attentional processing and working memory processing to emotional faces among adolescents with conduct disorder. 35 male adolescent delinquents with conduct disorder and 35 age-matched delinquents without conduct disorder completed a visual search task and a delayed-match-to-sample task to examine their attentional processing and working memory processing for sad, angry, happy, and fearful faces, respectively. It was found that conduct disordered individuals searched angry and fearful faces, rather than sad and happy faces, more slowly than individuals without conduct disorder. However, no difference in mnemonic processing for facial emotions was found between groups. The results indicated that male adolescent delinquents with conduct disorder showed deficits in attentional orientation to hostile and threatening faces, supporting the optimal stimulation/arousal theory, the stimulation-seeking theory and the fearlessness theory, but not the social-cognitive theory.

Maternal History of Child Sexual Abuse and Maladaptive Outcomes in Sexually Abused Children: The Role of Maternal Mental Health

The effects of child sexual abuse (CSA) have been found to surpass generations as maternal history of CSA is associated with increased difficulties in sexually abused children. However, little is known about the mechanisms underlying this association. The present study aimed to test maternal mental health symptoms including psychological distress, post-traumatic stress disorder (PTSD) symptoms, and dissociation as mediators of the relationship between maternal CSA and children's internalizing, externalizing, and dissociation symptoms in a large sample of sexually abused children. A total of 997 sexually abused children aged 3-14 years old and their mothers were recruited at five specialized intervention centers offering services to sexually abused children and their families. The children were divided into two groups depending on their mothers' self-reported history of CSA. Mothers completed a series of questionnaires assessing their mental health and children's functioning. Maternal history of CSA was associated with increased maternal psychological distress, PTSD symptoms, and dissociation following children's disclosure of CSA. In turn, maternal psychological distress and maternal dissociation were associated with increased child internalizing, externalizing, and dissociation symptoms. Maternal PTSD symptoms were associated with child internalizing symptoms. Maternal mental health difficulties mediated the association between maternal CSA and sexually abused children's maladaptive outcomes. Clinicians should assess for possible history of CSA in mothers of sexually abused children and determine how best to support them to cope with the aftermaths of their child's disclosure and with their own traumatic past.

Child Sexual Abuse, Self-esteem, and Delinquent Behaviors During Adolescence: The Moderating Role of Gender

To reflect the complex phenomena of child sexual abuse (CSA), studies should examine possible gender specificities and explore potentially explanatory mechanisms. The current study aimed to test the moderating effect of gender in the mediated relationship between CSA, self-esteem, and delinquency during adolescence. A moderated mediation model was tested among a representative sample of 8,194 high school students (57.8% girls and 42.2% boys) age 14 to 18 in the province of Quebec in Canada. Results showed that self-esteem has an indirect effect on the relationship between CSA and delinquency. Gender (being a boy) was associated with a higher level of self-esteem and an increased risk of delinquent behaviors. Among victims of CSA, boys reported lower levels of self-esteem than girls, which was associated with an increased risk of displaying delinquent behaviors. Self-esteem may be an important target of intervention for sexually abused youth, especially for boys. Focusing on promoting positive self-esteem may also reduce the risk for male adolescents struggling with the deleterious consequences of delinquency.

Associations between childhood maltreatment and psychiatric disorders: analysis from electronic health records in Hong Kong

There has been a lack of high-quality evidence concerning the association between childhood maltreatment and psychiatric diagnoses particularly for Axis II disorders. This study aimed to examine the association between childhood maltreatment exposure and Axis I and Axis II psychiatry disorders using electronic health records. In this study, the exposed group (n = 7473) comprised patients aged 0 to 19 years with a first-time record of maltreatment episode between January 1, 2001 and December 31, 2010, whereas the unexposed group (n = 26,834) comprised individuals of the same gender and age who were admitted into the same hospital in the same calendar year and month but had no records of maltreatment in the Hong Kong Clinical Data Analysis and Reporting System (CDARS). Data on their psychiatric diagnoses recorded from the date of admission to January 31, 2019 were extracted. A Cox proportional hazard regression model was fitted to estimate the hazard ratio (HR, plus 95% CIs) between childhood maltreatment exposure and psychiatric diagnoses, adjusting for age at index visit, sex, and government welfare recipient status. Results showed that childhood maltreatment exposure was significantly associated with subsequent diagnosis of conduct disorder/ oppositional defiant disorder (adjusted HR, 10.99 [95% CI 6.36, 19.01]), attention deficit hyperactivity disorder (ADHD) (7.28 [5.49, 9.65]), and personality disorders (5.36 [3.78, 7.59]). The risk of psychiatric disorders following childhood maltreatment did not vary by history of childhood sexual abuse, age at maltreatment exposure, and gender. Individuals with a history of childhood maltreatment are vulnerable to psychiatric disorders. Findings support the provision of integrated care within the primary health care setting to address the long-term medical and psychosocial needs of individuals with a history of childhood maltreatment.

Assessing and Responding to the Trauma of Child Maltreatment

Child maltreatment is a significant risk factor for severe psychiatric outcomes in childhood and contributes to problematic symptoms that direct parents, teachers, or other invested parties to seek psychiatric intervention. With ongoing workforce shortages, much of the pediatric psychiatric care to this population is delivered by generalists. Child maltreatment and trauma can critically alter a child's development trajectory, affecting potential success in school and other important life pursuits. In addition, child maltreatment and resultant traumatic stress can dramatically disrupt child and adolescent development of healthy emotional regulation, distress tolerance, and the ability to form effective interpersonal relationships. Such disruption can lead to presentations within children and adolescents that mimic other symptoms of psychopathology but that typically respond poorly to traditional psychopharmacology. Ineffective treatment trials can lead to increased risk of polypharmacy and inaccurate expectations for treatment benefits. Such treatment efforts may impede addressing important environmental contributors and delay indicated therapeutic strategies. This article seeks to review child maltreatment-including core features and prevalence, overlap of child maltreatment with adverse childhood experiences, developmental impacts of exposure and resultant traumatic stress, guidance for appropriate assessment, and evidence-based interventions-and provide basic deprescribing guidelines to reduce polypharmacy burden.

Psychosocial interventions for responding to child sexual abuse: A systematic review

BACKGROUND

In this manuscript, we summarize the findings of a systematic review that informed the development of the World Health Organization's recommendations related to psychosocial interventions for child and adolescent sexual abuse.

METHOD

Systematic searches across 14 databases were conducted to retrieve any published randomized controlled trials of psychosocial interventions addressing mental health outcomes among children and adolescents exposed to sexual abuse who have experienced symptoms. We assessed study risk of bias using the Cochrane Risk of Bias tool and certainty of the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.

RESULTS

Twenty-four articles representing fifteen studies were included in the systematic review. Only two studies were conducted in low- or middle-income countries. Few studies could be pooled together because of differences in interventions and comparators. Due to the small numbers of participants and very serious concerns with risk of bias, we are very uncertain about the benefits of interventions provided to children alone and without the involvement of their caregivers. However, cognitive behavior therapy (CBT) with a trauma focus provided to children and involving their caregivers may reduce some mental health symptoms associated with sexual abuse experiences.

DISCUSSION

The findings suggest that more and larger studies are needed to evaluate the effects of psychosocial interventions for children and adolescents exposed to sexual abuse who preside in low- and middle-income countries. PROSPERO registration number: CRD42016039656.

Prevalence and associated mental health outcomes of child sexual abuse in youth in France: Observations from a convenience sample

CONTEXT

Child sexual abuse (CSA) is an important public health problem associated with an array of negative consequences. Although prevalence rates are well established from North America, few studies have focused on the extent of CSA and associated outcomes in youth from France.

OBJECTIVES

This study aimed to: 1) estimate the prevalence of CSA, 2) assess the associations between CSA and health outcomes while exploring possible gender specificities and 3) document the contribution of revictimization on symptom complexity.

METHOD

The sample involved 2309 participants aged between 14 and 23 years old (M = 19.55). Measures assessing CSA, other forms of child maltreatment and mental health problems were administered. Sexual revictimization and a host of protective factors (resilience, coping strategies, parental support) were also assessed.

RESULTS

CSA was reported by 13.1% of girls and 4.2% of boys. Regression analyses revealed that CSA was associated with all mental health outcomes except alcohol and drug use (other than cannabis) after controlling for sociodemographics and other forms of child maltreatment. Sexual revictimization was associated with symptom complexity. Emotion-centered and avoidance coping predicted symptom complexity while resilience and paternal support acted as protective factors.

LIMITATIONS

The study relied on a cross-sectional design with a convenience sample, which limits the generalizability of results. The small number of boys reporting CSA precludes drawing firm conclusions as to the gender specificities in the outcomes associated with CSA.

CONCLUSIONS

Findings underscore the relevance of developing efficient prevention programs as CSA is linked to a host of negative outcomes.

Mental health disorders as cooccuring and predictive factors of psychotic disorders in sexually abused children

BACKGROUND

Little is known about the factors associated with psychosis in sexually abused children. Many factors have been associated with both sexual abuse and psychosis, and some mental health disorders have been identified as implied in the relationship between childhood trauma and psychosis.

OBJECTIVES

This study aims to identify factors cooccurring with psychotic disorders in sexually abused youth and to determine which predict the development of psychosis in this population.

PARTICIPANTS AND SETTING

Children with a corroborated report of sexual abuse (n = 882) at a Child Protection Agency (CPA) between 2000 and 2010 and whose health data could be retrieved from public health databases were selected for this study.

METHODS

A prospective matched-cohort design was used, with administrative databases from a CPA and a public health system. Logistic regressions were performed to determine which mental health diagnoses were associated with, and which predicted, psychotic disorders.

RESULTS

Logistic regressions revealed that personality disorders were significantly associated with psychotic disorders whereas substance misuse disorders and intellectual disability significantly predicted psychotic disorders.

CONCLUSIONS

Psychotic disorders and personality disorders appear concomitantly in sexually abused youth. Having received a substance misuse disorder diagnosis increases the risk of developing a psychotic disorder in sexually abused youth. Health professionals should be aware of those risk factors to help reduce the severity of youth sexual abuse consequences and, ultimately, prevent psychosis.

A Systematic Review of Reviews of the Outcome of Noninstitutional Child Maltreatment

The aim of the systematic review described in this article was to synthesize available high-quality evidence on the outcomes of noninstitutional child maltreatment across the life span. A systematic review of previous systematic reviews and meta-analyses was conducted. Ten databases were searched. One hundred eleven papers which met stringent inclusion and exclusion criteria were selected for review. Papers were included if they reported systematic reviews and meta-analyses of longitudinal or cross-sectional controlled studies, or single-group cohort primary studies of the outcomes of child maltreatment in the domains of physical and mental health and psychosocial adjustment of individuals who were children lived mainly with their families. Using AMSTAR criteria, selected systematic reviews and meta-analyses were found to be of moderate or high quality. Searches, study selection, data extraction, and study quality assessments were independently conducted by two researchers, with a high degree of interrater reliability. The 111 systematic reviews and meta-analyses reviewed in this article covered 2,534 independent primary studies involving 30,375,962 participants, of whom more than 518,022 had been maltreated. The magnitude and quality of this evidence base allow considerable confidence to be placed in obtained results. Significant associations were found between a history of child maltreatment and adjustment in the domains of physical health, mental health, and psychosocial adjustment in a very wide range of areas. The many adverse outcomes associated with child maltreatment documented in this review highlight the importance of implementing evidence-based child protection policies and practices to prevent maltreatment and treat child abuse survivors.

Impact of Alcohol Outlet Density on Reported Cases of Child Maltreatment in Japan: Fixed Effects Analysis

Background: Parental drinking habits or binge drinking are a known risk factor of child maltreatment. Though drinking habits are affected by alcohol outlet density, the direct association between alcohol outlet density and child maltreatment is still controversial.

Purpose: This study aimed to examine the impact of off-premises alcohol outlet density on child maltreatment cases reported to Child Guidance Centers in Japan.

Methods: A fixed effects model was used to investigate the association between a change in off-premises alcohol outlet density and a change in child maltreatment cases in each unit. Time-series of cross-sectional ecological data collected from across Japan over 16 years (2000 to 2015) was used, and maltreatment cases were further sub-grouped by type of maltreatment (physical, sexual, psychological abuse and neglect) and by perpetrators (father, stepfather, mother, and stepmother).

Results: The association between alcohol outlet density and total cases of child maltreatment was not observed (coefficient = 0.98, 95% confidence interval: −6.30, 8.25). However, alcohol outlet density was shown to be positively associated with neglect (coefficient = 3.08, 95% confidence interval: 0.54, 5.62), which indicates that 1 alcohol outlet per 1,000 adults increase would lead to 3 more neglect cases per 10,000 children. Also, a negative association was observed between a change in the incidence of total child maltreatment by father and a change in alcohol outlet density (coefficient = −3.03, 95% confidence interval: −5.78, −0.28).

Conclusion: The findings suggest that off-premises alcohol outlet density may have a causal effect on the increasing cases of neglect and decrease in maltreatment by father in Japan.

Childhood Sexual Abuse and Lifetime Aggression

This study of college undergraduates (N = 873) examined three hypotheses regarding associations between childhood sexual abuse and lifetime aggression: 1) childhood sexual abuse was expected to account for unshared variance in the lifetime aggression indicators after controlling for the potential effects of parental physical abuse, sibling physical abuse, exposure to intimate partner violence, peer bullying, and respondent age; 2) childhood sexual abuse associations were expected to be relatively stronger among the women than the men; 3) childhood sexual abuse links to lifetime aggression were expected to vary as a function of age of victimization (adolescent < childhood < dual-age victims). Aggression histories varied widely with over 20% reporting prior injuries inflicted on others (3.2% > five injuries). Sexual abuse links to aggression tended to be stronger (p < .001) for the women than the men, and rates of aggression were higher when sexual abuse recurred across both childhood and adolescence. Partial support was found for all three hypotheses.

Childhood Maltreatment and the Risk for Criminal Justice Involvement and Victimization Among Homeless Individuals: A Systematic Review

Homeless individuals are at higher risk of criminal justice involvement (CJI) and victimization compared to their housed counterparts. Exposure to childhood maltreatment (CM; e.g., abuse, neglect) is one of the most significant predictors of CJI and victimization among homeless populations. The aim of this systematic review was to synthesize current knowledge regarding the relationship between CM and CJI and victimization among homeless individuals. Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methods, a systematic search was performed using PsycINFO, MEDLINE, Embase, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature for published studies investigating the relationship between CM and CJI and victimization among homeless samples. We identified 20 studies that met the inclusion criteria. Findings showed that across the majority of studies, CM, and in particular childhood physical (CPA) and sexual (CSA) abuse, is associated with increased risk of both CJI and victimization, regardless of various important factors (e.g., sociodemographic characteristics, psychiatric disorders, substance use). These findings support the need for prevention and treatment for "families at risk" (i.e., for intimate partner violence, child abuse and neglect) and also document the need for trauma-informed approaches within services for homeless individuals. Future research should focus on prospective designs that examine victimization and CJI in the same samples.

Child sexual abuse, disclosure and PTSD: A systematic and critical review

BACKGROUND

Child sexual abuse (CSA) is a prevalent exposure with potentially serious, negative health consequences, including post-traumatic stress disorder (PTSD) and its symptomatology.

OBJECTIVE

To conduct a systematic and critical review in order to investigate the relationship between CSA disclosure patterns and PTSD.

PARTICIPANTS AND SETTING

Studies included clinical, college and community-based samples of adults' and children's experiences of CSA.

METHODS

We conducted systematic searches in five databases (Medline, Embase, PyscINFO, CINAHL, ERIC, Sociological Abstracts) from database inception to October 17, 2017 using index terms and keywords for CSA, disclosure, and PTSD. We included any English-language, primary studies involving children or adults with experiences of CSA that used quantitative research designs to explore the relationship between disclosure and PTSD. We used systematic critical review methodology in order to investigate the relationship between disclosure and PTSD symptoms and disorders. We also investigated factors that explained the relationship between disclosure and PTSD, such as individual, exposure or environmental factors.

RESULTS

Twenty-two articles reporting 20 studies were included in this review. Studies assessing the relationship between CSA and PTSD tended to account for personal (e.g., gender) and CSA exposure variables (e.g., severity of CSA) only. While authors generally used validated measures to assess for PTSD symptoms and disorders, they tended to use author-generated or unvalidated measures to assess for disclosure process variables.

CONCLUSION

The relationship between factors that affect disclosure, and responses to disclosure, are not well theorized in quantitative literature. Study findings suggest important avenues for future research, such as the need to assess disclosure longitudinally.

Conduct disorder in adolescent females: current state of research and study design of the FemNAT-CD consortium

Conduct disorder (CD) is a common and highly impairing psychiatric disorder of childhood and adolescence that frequently leads to poor physical and mental health outcomes in adulthood. The prevalence of CD is substantially higher in males than females, and partly due to this, most research on this condition has used all-male or predominantly male samples. Although the number of females exhibiting CD has increased in recent decades, the majority of studies on neurobiological measures, neurocognitive phenotypes, and treatments for CD have focused on male subjects only, despite strong evidence for sex differences in the aetiology and neurobiology of CD. Here, we selectively review the existing literature on CD and related phenotypes in females, focusing in particular on sex differences in CD symptoms, patterns of psychiatric comorbidity, and callous-unemotional personality traits. We also consider studies investigating the neurobiology of CD in females, with a focus on studies using genetic, structural and functional neuroimaging, psychophysiological, and neuroendocrinological methods. We end the article by providing an overview of the study design of the FemNAT-CD consortium, an interdisciplinary, multi-level and multi-site study that explicitly focuses on CD in females, but which is also investigating sex differences in the causes, developmental course, and neurobiological correlates of CD.

Cumulative childhood trauma, emotion regulation, dissociation, and behavior problems in school-aged sexual abuse victims

BACKGROUND

Child sexual abuse is associated with a plethora of devastating repercussions. A significant number of sexually abused children are likely to experience other forms of maltreatment that can seriously affect their emotion regulation abilities and impede on their development. The aim of the study was to test emotion regulation and dissociation as mediators in the association between cumulative childhood trauma and internalized and externalized behavior problems in child victims of sexual abuse.

METHODS

Participants were 309 sexually abused children (203 girls and 106 boys; Mean age = 9.07) and their non-offending parent. Medical and clinical files were coded for cumulative childhood trauma. At initial evaluation (T1), parents completed measures assessing children's emotion regulation abilities and dissociation. At Time 2 (T2), parents completed a measure assessing children's behavior problems. Mediation analyses were conducted with emotion regulation and dissociation as sequential mediators using Mplus software.

RESULTS

Findings revealed that cumulative childhood trauma affects both internalized and externalized behavior problems through three mediation paths: emotion regulation alone, dissociation alone, and through a path combining emotion regulation and dissociation.

LIMITATIONS

Both emotion regulation and dissociation were assessed at T1 and thus the temporal sequencing of mediators remains to be ascertained through a longitudinal design. All measures were completed by the parents.

CONCLUSIONS

Clinicians should routinely screen for other childhood trauma in vulnerable clienteles. In order to tackle behavior problems, clinical interventions for sexually abused youth need to address emotion regulation competencies and dissociation.

Childhood adversity and conduct disorder: A developmental pathway to violence in schizophrenia

BACKGROUND

Both childhood adversity and conduct disorder are over-represented among adult patients with schizophrenia and have been proposed as significant factors that may increase the risk of violence. It is not known how childhood adversity and conduct disorder might interact to contribute towards an increased risk of violence in schizophrenia. This study aimed to explore the relationships between childhood adversity, conduct disorder and violence among men with schizophrenia.

METHODS

54 male patients with schizophrenia from a range of inpatient and outpatient mental health services were assessed for exposure to a variety of childhood adversities, conduct disorder before the age of 15 and later violent behaviour in adulthood.

RESULTS

Exposure to domestic violence during childhood was associated with an increased propensity to violence in adulthood. Symptoms of conduct disorder were associated both with cumulative exposure to childhood adversities and with later propensity to violence. The cumulative number of childhood adversities was associated with adult propensity to violence. This association was significantly attenuated by inclusion of conduct disorder in the model.

CONCLUSIONS

This is the first study to demonstrate an association between childhood exposure to domestic violence and later violent behaviour in schizophrenia. Conduct disorder may mediate the association between cumulative childhood adversities and adult propensity to violence, indicating an indirect pathway. These results indicate a complex interplay between childhood adversity, conduct disorder and later violent behaviour in schizophrenia, and suggest that there may be shared aetiological risk factors on a common developmental pathway to violence.

A bihemispheric autonomic model for traumatic stress effects on health and behavior

A bihemispheric autonomic model (BHAM) may support advanced understanding of traumatic stress effects on physiology and behavior. The model builds on established data showing hemispheric lateralization in management of the autonomic nervous system, and proposes that traumatic stress can produce dominant asymmetry in activity of bilateral homologous brain regions responsible for autonomic management. Rightward and leftward dominant asymmetries are associated with sympathetic high arousal or parasympathetic freeze tendencies, respectively, and return to relative symmetry is associated with improved autonomic regulation. Autonomic auto-calibration for recovery (inverse of Jacksonian dissolution proposed by polyvagal theory) has implications for risk behaviors associated with traumatic life stress. Trauma-induced high arousal may be associated with risk for maladaptive behaviors to attenuate arousal (including abuse of alcohol or sedative-hypnotics). Trauma-induced freeze mode (including callous-unemotional trait) may be associated with low resting heart rate and risk for conduct disorders. The model may explain higher prevalence of leftward hemispheric abnormalities reported in studies of violence. Implications of the BHAM are illustrated through case examples of a military special operations officer with history of traumatic brain injury and post-traumatic stress disorder, and a university student with persisting post-concussion symptoms. Both undertook use of a noninvasive closed-loop neurotechnology - high-resolution, relational, resonance-based, electroencephalic mirroring - with ensuing decrease in hemispheric asymmetry, improvement in heart rate variability, and symptom reduction. Finally, the BHAM aligns with calls for researchers to use brain-behavioral constructs (research domain criteria or RDoC, proposed by the National Institutes of Mental Health) as building blocks for assessment and intervention in mental health science.