Childhood sexual exploitation: long-term effects among a group of nursing students

The prevalence of childhood adversity among healthcare workers and its relationship to adult life events, distress and impairment

OBJECTIVE

We investigated the prevalence of childhood adversity among healthcare workers and if such experiences affect responses to adult life stress.

METHODS

A secondary analysis was conducted of a 2003 study of 176 hospital-based healthcare workers, which surveyed lifetime traumatic events, recent life events, psychological distress, coping, social support, and days off work due to stress or illness.

RESULTS

Sixty eight percent (95% CI 61.1-74.9) of healthcare workers had one or more experience of violence, abuse or neglect, 33% (95% CI 26.1-40.0) before the age of 13. Compared to healthcare workers who did not experience childhood adversity, those who did reported more recent life events (median 11 vs. 5 over the previous 6 months, p<.001) and greater psychological distress (median score 17 vs. 13, p<.001). The relationship between life events and psychological distress was not linear. Most healthcare workers without childhood adversity (73%) reported a low number of life events which were not associated with psychological distress. Most healthcare workers with childhood adversity (81%) reported a higher number of life events, for which the correlation between events and distress was moderately strong (Spearman's rho=.50, p<.001). Childhood adversity was also associated with more missed work days. Each of these outcomes was higher in 22 healthcare workers (13%) who had experienced more than one type of childhood adversity.

CONCLUSIONS

Childhood adversity is common among healthcare workers and is associated with a greater number of life events, more psychological distress and impairment.

Retrospective measurement of childhood sexual abuse: a review of instruments

In this comprehensive review of retrospective childhood sexual abuse (CSA) instruments, instruments from studies published between 1986 and 2001 are examined according to administration method, number and specificity of questions, CSA operational definitions, psychometric properties, and the use of scales. It was found that both self-administered and interview instruments range from the vagueness of a single question to the preciseness of multiple, specific questions. Furthermore, the review demonstrated that CSA instruments generally lack standardization. Many are developed for one-time use and others modified when reused. Descriptive CSA instruments have been preferred by researchers and primarily used to measure CSA dichotomously. However, little consensus exists as to how to operationally define CSA. One positive trend is the development of scales that measure CSA as an interval-level variable, allowing for more extensive psychometric data to be collected.

Child and adolescent sexual abuse history in a sample of 1,490 women sexual partners of injection drug-using men

Subjects for this study were 1490 community-recruited women sexual partners of injection drug-using men who were interviewed in three U.S. cities during 1990-'92. Data were collected on respondents' childhood and adolescent sexual abuse history, identity of abuse perpetrators and duration of abuse. Over 56 percent of respondents reported a history of sexual victimization by age 18, including 39 percent who were abused before age 12 and over 53 percent who were victimized by abuse involving bodily contact by age 18. One in three women were victimized by unwanted penetration by age 18. White women more likely than African-American and Hispanic women to have been the victims of virtually every type of abusive act investigated here. Overall, nearly two out of three White women had experienced some form of sexual abuse by age 18, including almost 42 percent who were the victims of unwanted penetration by this age. Acts of forced sexual touching and penetration occurring in childhood were most likely to have been carried out by an uncle or other relative of the victim; family members were much less likely to be the perpetrators of adolescent contact abuse. Based on these findings, it appears that many in this special population of women are likely to be at substantial risk for some of the long-term effects of early life sexual abuse, including those that may reduce victims' ability to take preventive action against HIV risk. Recommendations are offered for those who function as caregivers to this population, including drug treatment personnel.

Unwanted sexual experiences reported by nursing students: implications for nurse education and training

This study examined the nature and frequency of unwanted sexual experiences in childhood and adulthood reported by nursing students, using a questionnaire developed from the Sexual Events Questionnaire (Calam & Slade). The questionnaire was distributed to 109 second-year nursing students (90 female and 19 male) for anonymous completion. At the same time a further short questionnaire asked students about their perceptions of the first questionnaire, and how far their course had, up to the present, included consideration of issues related to sexuality. A high level of unwanted sexual experiences was reported. For example: 49 (45.0%) reported having witnessed indecent exposure; 27 (24.8%) reported someone having 'tried unsuccessfully to have sexual intercourse with you against your will'; 14 (12.8%) reported someone having 'succeeded in having sexual intercourse with you against your will'. In the second questionnaire, 74.1% thought that consideration of human sexuality had so far been included in their course either 'not at all' or 'a little', with 19.4% responding 'quite a lot' or 'very much'. It is argued that there is a particular need, for personal and professional reasons, for nursing students to have opportunities to address any unresolved effects of unwanted sexual experiences, and that within the formal curriculum there should be greater consideration of issues related to human sexuality.

The impact of childhood sexual abuse on the psychological well-being and practice of nurses

This study compares the psychological well-being of nurses who were sexually abused as children with those who were not abused and considers the impact of this abuse on aspects of their clinical practice. On the psychological measures, abused nurses differed from the nonabused nurses by having significantly higher distress scores and lower self-esteem scores. For some nurses, the abuse influenced their private and professional relationships including personal sexual relationships and working with other health professionals. These results highlight the need for the educational and health care systems to consider the needs of health care professionals who may have been abused.

A meta-analysis of the relationship of child sexual abuse to adult psychological adjustment

This paper reports on meta-analyses of the relations of child sexual abuse to adult psychological adjustment. Results indicated statistically significant relationships between the experience of child sexual abuse and subsequent difficulties in psychological adjustment as measured by psychological symptomatology, depression, and self-esteem. Significant heterogeneity occurred across studies using a variety of different subject populations, research designs, and assessment methods. Some explanation of the effect size variance was partially accounted for by certain identified study characteristics, most notable in regard to sample source used in the included studies. Student samples consistently generated smaller, more homogeneous effect size estimates than did community or clinical samples. This indicates that abused subjects drawn from student samples may experience fewer impairments in psychological adjustment, when compared to abused subjects drawn from community or clinical samples. The implications of these findings and suggestions for future research are discussed.

Symptoms of female survivors of child sexual abuse

Women who suffered sexual abuse as children often experience a variety of physical and psychosocial symptoms as adults. Identifying this pattern of symptoms might assist health professionals in recognizing and treating nonreporting survivors of child sexual abuse. In this study, the Adult Survivors of Incest (ASI) Questionnaire (Brown & Garrison, 1990) was used to determine the symptoms and contributing factors for 22 adult survivors of child sexual abuse. Six physical symptoms were experienced by 50% of the subjects, and over 75% of the subjects experienced 11 psychosocial symptoms. The number of physical symptoms correlated significantly with other victimizations (r = .59) and number of psychosocial symptoms (r = .56). The findings suggest that the ASI Questionnaire was effective in identifying patterns of symptoms and contributing factors of adult survivors of child abuse. Additional study is needed to determine the usefulness of this questionnaire in identifying nonreporting survivors in clinical situations.

Self-esteem, anxiety, and loneliness in preadolescent girls who have experienced sexual abuse

This study sought to clarify and extend existing knowledge of the negative sequelae of sexual abuse by comparing levels of self-esteem, anxiety, and loneliness in abused and nonabused girls. Comparisons indicated that sexually abused children had lower levels of self-esteem than nonabused children, but that levels of anxiety and loneliness did not differ between the groups. These findings empirically confirm one of the sequelae of sexual abuse commonly cited in the clinical literature and point to the need for interventions designed to redress this adverse effect.

THAT WAS THEN: ELDERLY SURVIVORS OF INCEST

1. Psychosocial ramifications of incest last a lifetime for some and may be of crucial importance in treating patients in the later developmental stages of life. 2. Nursing assessments that include current and past history of violence are important for understanding presenting symptomology and interpersonal dynamics, but they are often neglected. 3. There is a need for nursing research that looks at all facets of elderly incest survivors, including incidence, late life symptomology, and special treatment needs.

A comparative study among college students of sexual abuse in childhood

A disproportionate random sample (200 women, 400 men) of students attending a major university was invited to participate in a mailed survey to study differences in self-efficacy, coping, and well-being between men and women who were sexually abused in childhood and those who were not. A total of 271 students (111 women, 160 men) responded by returning the completed survey. Fifty percent of the women and 22% of the men in the sample reported one or more unwanted sexual experiences in childhood. Multivariate analysis of variance (MANOVA) techniques to analyze differences in self-efficacy, coping (confrontive, emotive, palliative), and well-being between women and men who reported childhood sexual abuse and those who did not showed significant interaction effects by sex for abuse (F = 2.609, P = .025, df 5,263) and significant effects by sex (F = 3.356, P = .006), but no significant differences for abuse alone. Univariate F tests were significant (F = 5.386, P = .021) for palliative coping with abused men reporting the highest scores, abused and nonabused women having the highest scores on emotive coping (F = 9.049, P = .003), and nonabused men and women having highest scores on well-being (F = 7.276, P = .007). A second MANOVA was performed on data from 245 students (nonabused and those who reported contact sexual abuse). Significant interaction effects by sex for abuse (F = 2.259, P = 0.49, df 5,237) and main effects for abuse (F = 3.225, P = .008) were found. Although abused men scored lowest on well-being, both abused men and abused women scored higher on emotive coping and lower on well-being than nonabused subjects. These are new findings with implications for developing and testing nursing interventions for this vulnerable group of young adults.