Severe interpersonal violence against children in sport: Associated mental health problems and quality of life in adulthood

In a recent large-scale prevalence study of interpersonal violence (IV) against child athletes in the Netherlands and Belgium we found that 9% of adult respondents who participated in organized sports before the age of 18 had experienced severe psychological violence, 8% severe physical violence, and 6% severe sexual violence in various sport settings. While the general literature has repeatedly shown that exposure to IV during childhood is associated with mental health problems in adulthood and to a lesser extent with reduced quality of life (QOL), these relationships have not been demonstrated in (former) athletes. Thus, the current study aims to assess the association of severe childhood IV in sport and adult wellbeing. Depression, anxiety, and somatization were assessed in the same general population sample (N = 4043) using the Brief Symptom Inventory (BSI-18) and QOL with the World Health Organization Quality of Life questionnaire (WHOQOL-Brèf). The association between severe IV in sport and adult wellbeing was investigated using multiple linear regression while controlling for demographics, recent life events, and relatives’ psychological problems. We found severe sexual, physical, and psychological childhood IV in sport to be associated with more adult psychological distress and reduced QOL. Polyvictimization shows the strongest correlation with poorer wellbeing and QOL. Recent life events, relatives’ psychological problems, marital status, and level of education were significant covariates in the psychological symptoms and QOL assessed. We hope that these new insights prompt sport administrators to implement broad spectrum child protection measures and raise the awareness of mental health professionals about the necessity to also screen for adverse childhood experiences in the sport context.     

Child and adolescent abuse and subsequent victimization: a prospective study

OBJECTIVE: We investigated the possible reciprocal relationship between victimization experiences and psychological functioning by assessing abuse experiences in childhood, adolescence, and during a 2-month follow-up period. METHOD: At the beginning of the study (Time 1), abuse histories, trauma and depressive symptoms, and interpersonal functioning were assessed in 551 college women. Subsequent victimization experiences and psychological outcomes were assessed at the follow-up (Time 2). RESULTS: Path analyses indicated that verbal abuse by the mother and father were predictive of various psychological outcomes as measured at Time 1 and emerged as the only significant predictors of adolescent dating violence. Adolescent dating violence subsequently predicted the experience of dating violence during the 2-month follow-up period. Paternal physical abuse predicted adolescent sexual victimization which subsequently predicted all symptom measures at Time 1. Conversely, the experience of adolescent physical dating violence was not predictive of any of the symptom measures at Time 1. For those women who experienced dating violence during the follow-up, however, the severity of their abusive experiences was related to both depression and interpersonal problems assessed at Time 2. In comparison, for those women who experienced sexual victimization during the follow-up period, the severity of their abusive experiences was related to trauma symptoms. Interpersonal problems emerged as both an aftereffect of adolescent sexual victimization experience and a predictor of a subsequent sexual victimization experience during the follow-up. CONCLUSIONS: Given that emotional abuse emerged as a predictor of adolescent dating violence and psychological outcomes, researchers and clinicians need to continue to explore this problem. Further, it is important to assess how interpersonal problems contribute to the risk of subsequent sexual victimization and to try to break the cycle between adolescent abuse experiences and subsequent physical and sexual assaults.     

Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women

OBJECTIVE: This study examined the prevalence and psychological sequelae of childhood sexual and physical abuse in adults from the general population. METHOD: A national sampling service generated a geographically stratified, random sample of 1,442 subjects from the United States. Subjects were mailed a questionnaire that included the Traumatic Events Survey (TES) [Traumatic Events Survey, Unpublished Psychological Test, Harbor-UCLA Medical Center, Los Angeles] and the Trauma Symptom Inventory (TSI) [Trauma Symptom Inventory Professional Manual, Psychological Assessment Resources, Odessa, FL]. Of all potential subjects, 935 (64.8%) returned substantially completed surveys. RESULTS: Sixty-six men and 152 women (14.2% and 32.3%, respectively) reported childhood experiences that satisfied criteria for sexual abuse, and 103 males and 92 females (22.2% and 19.5%, respectively) met criteria for physical abuse. Twenty-one percent of subjects with one type of abuse also had experienced the other type, and both types were associated with subsequent adult victimization. After controlling for demographics, adult history of interpersonal violence, and other child abuse, childhood sexual abuse was associated with all 10 scales of the TSI, and physical abuse was related to all TSI scales except those tapping sexual issues. Sexual abuse predicted more symptom variance than did physical abuse or adult interpersonal victimization. Various aspects of both physical and sexual abuse experiences were predictive of TSI scores. Abuser sex, however, both alone and in interaction with victim sex, was not associated with additional TSI symptomatology. CONCLUSIONS: Childhood sexual and physical abuse is relatively common in the general population, and is associated with a wide variety of psychological symptoms. These relationships remain even after controlling for relevant background variables.     

Victimization during childhood and revictimization in dating relationships in adolescent girls

OBJECTIVE: Various experiences with violence during childhood and adolescence (parental violence, exposure to marital violence, sexual abuse within and outside the family, sexual harassment at school, community violence, involvement with violent or victimized peers, and previous dating violence) are examined as potential risk factors for psychological, physical, and sexual revictimization in adolescent girls' dating relationships. METHOD: A group of 917 teenage girls (mean age = 16.3) were recruited in 5 high schools located in low to middle socioeconomic areas. Participants were in the 10th and 11th grades, and each completed a self-administered questionnaire. Analyses were performed on the 622 participants who reported having at least one dating partner in the last 12 months. RESULTS: Prevalence rates for past victimization experiences varied from 13% to 43%. Regarding last-year dating victimization, prevalence rates varied from 25% to 37%, depending on the type of violence sustained. Results suggest that extrafamilial experiences with violence are stronger risk factors for recent dating victimization than intrafamilial experiences, especially being sexually harassed by male peers at school and being involved with violent or victimized peers during the year preceding the survey. However, it is important to differentiate between girls who are repeatedly victims of violence in a single, long-term relationship (repeat dating victimization), and girls who are revictimized by different partners (dating revictimization), the former sustaining more frequent physical and psychological violence than the latter. CONCLUSIONS: Findings underline the importance of early prevention of adolescent dating violence. Prevention programs should especially address extrafamilial experiences with violence as important risk factors for victimization in dating relationships, and teach girls strategies to break up abusive relationships.     

Associations between childhood abuse and interpersonal aggression and suicide attempt among U.S. adults in a national study

The aim of this study is to examine associations among childhood physical, emotional, or sexual abuse and violence toward self (suicide attempts [SA]) and others (interpersonal aggression [IA]). Data were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions Waves 1 and 2 (n = 34,653). Multinomial logistic regression examined associations between type of childhood abuse and violence categories, adjusting for demographic variables, other childhood adversity, and DSM-IV psychiatric disorders. The prevalence of reported childhood abuse was 4.60% for physical abuse, 7.83% for emotional abuse, and 10.20% for sexual abuse. Approximately 18% of adults reported some form of violent behavior, distributed as follows: IA, 13.37%; SA, 2.64%; and SA with IA, 1.85%. After adjusting for demographic variables, other childhood adversity, and psychiatric disorders, each type of childhood abuse was significantly related to increased risk for each violence category as compared with the no violence category. Furthermore, the odds ratio of childhood physical abuse was significantly higher for SA with IA when compared with IA, and the odds ratio of childhood sexual abuse was significantly higher for SA and SA with IA when compared with IA. Childhood physical, emotional, and sexual abuse is directly related to the risk for violent behaviors to self and others. Both internalizing and externalizing psychiatric disorders impact the association between childhood abuse and violence. The inclusion of suicidal behaviors and interpersonal aggression and internalizing/externalizing psychiatric disorders within an integrated conceptual framework will facilitate more effective interventions for long-lasting effects of child abuse.     

Sex and sexual orientation disparities in adverse childhood experiences and early age at sexual debut in the United States: Results from a nationally representative sample

Adverse childhood experiences (ACEs) have been linked to early sexual debut, which has been found to be associated with multiple adverse health outcomes. Sexual minorities and men tend to have earlier sexual debut compared to heterosexual populations and women, respectively. However, studies examining the association between ACEs and early sexual debut among men and sexual minorities are lacking. The aim of this study was to examine the sex and sexual orientation disparities in the association between ACEs and age at sexual debut. Data were obtained from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and linear regression models were used to obtain crude and adjusted estimates and 95% confidence intervals adjusting for age, race/ethnicity, income, education, insurance and marital status for the association between ACEs (neglect, physical/psychological abuse, sexual abuse, parental violence, and parental incarceration and psychopathology) and early sexual debut. Analyses were stratified by sex and sexual orientation. Larger effect estimates depicting the association between ACEs and sexual debut were seen for women compared to men, and among sexual minorities, particularly among men who have sex with men (MSM) and women who have sex with women (WSW), compared to heterosexuals. Sexual health education programs with a focus on delaying sexual debut among children and adolescents should also consider addressing ACEs, such as neglect, physical, psychological and sexual abuse, witnessing parental violence, and parental incarceration and psychopathology. Public health practitioners, researchers and sexual health education curriculum coordinators should consider these differences by sex and sexual orientation when designing these programs.     

Predicting the use of single versus multiple types of violence towards children in a representative sample of Quebec families

OBJECTIVE: The purpose of this study is to determine which factors best predict parental use of single versus multiple types of violence. METHODOLOGY: The study uses data from a Quebec telephone survey conducted with a representative sample of 2,469 mothers of children aged 0-17 years. The interview covered topics such as mother's attitudes and reports of violence towards children, mother's experiences of childhood violence, level of marital discord, and socioeconomic factors. A discriminant function analysis was performed using individual and family factors to predict membership in five distinct groups: (a) no violence reported; (b) reports of psychological aggression only; (c) reports of minor physical violence only; (d) reports of psychological aggression and minor physical violence; and (e) reports of psychological aggression, minor and severe physical violence. RESULTS: One-way ANOVAs revealed that the groups differed significantly on factors such as child's age and gender, mother's attitudes, mother's experiences of childhood violence, level of marital discord, and number of children in the household. Discriminant function analysis revealed that the groups differed in two ways. The first function maximally separated the report of psychological aggression from minor physical violence only. The second function discriminated between the combined reports of all three types of violence versus the reports of minor physical violence only. Mother's attitudes and experiences of childhood violence were the two factors that best distinguished among groups and best predicted group membership. CONCLUSION: These results offer new insights for the prediction of mother's reports of one type versus multiple types of violence and highlight the importance of distinguishing between types and combinations of family violence in future research.     

Child sexual and physical abuse among college students in Singapore and the United States

OBJECTIVES: The purpose of this study was to explore differences in rates and characteristics of child sexual and physical abuse experiences among women in Singapore and the US. METHOD: Participants (N=153) completed an anonymous questionnaire which assessed experiences of childhood sexual and physical abuse, abuse characteristics (e.g., victimization age, severity), and behavioral and subjective reactions to such experiences (e.g., labeling of experiences as abuse, psychological symptomatology). Exposure to other forms of traumatic life events was also assessed. RESULTS: In comparison to Singaporean women, US women were more likely to report a history of child sexual abuse, and to report experiencing more severe forms of sexual abuse. Women in Singapore were more likely than women in the US to report a history of child physical abuse, to report experiencing injury as a result of the abuse, and to disclose the abuse. Singaporean women with a history of child sexual abuse reported elevated psychological symptom levels relative to their nonabused peers and to US women with a history of child sexual abuse, even after controlling for exposure to other types of traumatic events. No significant differences in symptomatology with regard to child physical abuse were observed. CONCLUSIONS: Although preliminary in nature, the present findings are among the first to demonstrate differences in psychological adjustment between sexually abused and nonabused Asian women living in Asia. This study also provides some of the first support for cross-national differences in the psychological adjustment of child sexual abuse survivors.     

Exploring revictimization process among Turkish women: The role of early maladaptive schemas on the link between child abuse and partner violence

The purpose of the current study is to explore the revictimization process between child abuse and neglect (CAN), and intimate partner violence (IPV) based on the schema theory perspective. For this aim, 222 married women recruited in four central cities of Turkey participated in the study. Results indicated that early negative CAN experiences increased the risk of being exposed to later IPV. Specifically, emotional abuse and sexual abuse in the childhood predicted the four subtypes of IPV, which are physical, psychological, and sexual violence, and injury, while physical abuse only associated with physical violence. To explore the mediational role of early maladaptive schemas (EMSs) on this association, first, five schema domains were tested via Parallel Multiple Mediation Model. Results indicated that only Disconnection/Rejection (D/R) schema domains mediated the association between CAN and IPV. Second, to determine the particular mediational roles of each schema, eighteen EMS were tested as mediators, and results showed that Emotional Deprivation Schema and Vulnerability to Harm or Illness Schema mediated the association between CAN and IPV. These findings provided an empirical support for the crucial roles of EMSs on the effect of revictimization process. Clinical implications were discussed.     

The mediating role of stigmatization in the mental health of adolescent victims of sexual violence in Eastern Congo

This study aims to explore the factors that explain the mental sequelae of war-related sexual violence and focuses in particular on the role of stigmatization. Drawing on a large-scale quantitative survey undertaken in the war-affected region of eastern Democratic Republic of the Congo, we analyze how stigmatization mediates the mental health impact of sexual violence on adolescent girls who were victims of rape. Twenty-two secondary schools were randomly selected out of a stratified sample in Bunia, Eastern Congo. In a cross-sectional, population-based survey, 1,305 school-going adolescent girls aged 11–23 completed self-report measures assessing war-related traumatic events, experiences of sexual violence, stigmatization, and mental health symptoms. Of the 1,305 participants, 38.2% (n = 499) reported experiences of sexual violence. Victims of sexual violence reported more war-related traumatic events and more stigmatization experiences. Several hierarchical regression analyses examined the mediating impact of stigmatization on the relationship between sexual violence and mental health outcomes, thereby controlling for sociodemographics (age, parental availability, and socioeconomic status) and war-related traumatic exposure. Our findings show that this stigmatization largely explains the mental health impact of sexual violence, in particular, on adolescent girls’ reported symptoms of depression (full mediation) and posttraumatic stress (avoidance and total PTSD: full mediation; hyperarousal: partial (40%) mediation). No evidence of mediation by stigmatization was found for symptoms of anxiety and intrusion. Stigmatization plays thus an important role in shaping the mental sequelae of sexual violence, a finding with major consequences for clinical practice.     

Child sexual abuse in China: a study of adolescents in four provinces

OBJECTIVE: Little is known about Child Sexual Abuse (CSA) in Chinese societies. This study examined CSA experiences and associations with demographic factors, self-reported health and risky behaviors among senior high school students in four provinces in central and northern China. METHOD: Students in four schools in Hubei, Henan, Hebei, and Beijing provinces participated in an anonymous, self-completed questionnaire survey. From a total enrollment of 3,261 students in the target classes in years 11 and 12, 2,300 (70.5%) returned valid questionnaires. Mean age was 17.2 years. The questionnaire was adapted from prior CSA research in Australia and utilized standard scales for depression, self-esteem, and youth risk behavior. RESULTS: Prevalence of any unwanted sexual experience before the age of 16 years was higher among females (16.7%) than males (10.5%). Sexual penetration was rarely reported (1%), while 7% reported at least one type of physical contact abuse (female 8.9%, male 5.0%). Risk of any CSA was not associated with the existence of siblings (one-child vs. two- or more child families), rural/urban residence during childhood, or parental education. Males and females with CSA were more depressed and suicidal, and drank alcohol more often, than unaffected adolescents. Contact CSA was strongly associated with sexual intercourse (ever) for both males and females. Females with CSA were more likely than others to engage in anorexic and bulimic behaviors, while males with CSA were often involved in violence. CONCLUSION: Social norms for consensual sexual experiences differ between Eastern and Western societies. CSA experiences also differ, with substantially less penetrative and physical contact abuse in China. However, the psychological and behavioral profile of abused, young Chinese people, including the additional burden associated with contact abuse, is similar to that found in other cultures.     

Interpersonal Violence and Sexual Assault: Trauma-Informed Communication Approaches in University Counseling Centers

A university in the United States Mountain West utilized grant resources to track counseling services for students who were currently experiencing or who had historically experienced relationship violence, sexual assault and/or stalking. This report reflects on the first 2 years of this program, including an overview of prevalence and reporting rates of interpersonal violence from university students. Given the prevalence of recent and historic interpersonal violence among university students, suggestions are offered for bringing a trauma-informed and communication-focused perspective to the solution-focused brief therapy model used in many university counseling centers. A case study outlining these approaches is offered.     

Protective factors associated with resilient functioning in young adulthood after childhood exposure to violence

Children may be subjected to many forms of violence and a significant number will experience multiple victimizations. These children are at high risk for developing psychological and emotional difficulties that may last into adulthood. Despite the increased risk for psychopathology, a substantial percentage of young adults exhibit resilient functioning following a history of childhood violence. This study examines the role of social support, spirituality, and emotional intelligence in promoting resilience during emerging adulthood. Participants included 321 young adult American college students, age 18–24, who experienced childhood violence, including community violence, interpersonal aggression, child maltreatment, peer/sibling victimization, and/or sexual assault. Findings revealed that this sample was highly victimized, with an average of 9 violent experiences reported during childhood. Hierarchical multiple regression analyses indicated that after controlling for exposure to childhood victimization, other potentially traumatic events, and current depression and anxiety symptoms, higher resilience during emerging adulthood was associated with greater spirituality, greater emotional intelligence, and support from friends (but not from family). Findings suggest that the potency of protective factors outweighs that of adversity and psychopathology when predicting resilient functioning. By identifying variables that can enhance resilience, this study offers unique insight into how functioning may be improved by both individual and environmental factors.     

Developmental experiences of child sexual abusers and rapists

OBJECTIVE: The aim of this study is to identify the distinct developmental experiences associated with child sexual abuse and rape. METHOD: For 269 sexual offenders (137 rapists and 132 child sexual abusers), developmental experiences were recorded from a behavioral checklist, a parental-bonding survey, and a sexual history questionnaire. Offender classification was obtained from official records and verified through polygraph examinations. RESULTS: Compared to rapists, child sexual abusers reported more frequent experiences of child sexual abuse (73%), early exposure to pornography (65% before age 10), an earlier onset of masturbation (60% before age 11), and sexual activities with animals (38%). In contrast to child sexual abusers, rapists reported more frequent experiences of physical abuse (68%), parental violence (78%), emotional abuse (70%), and cruelty to animals (68%). Both child sexual abusers and rapists (>93%) reported frequent exposure to violent media during their childhood. Most offenders (94%) described having insecure parental attachment bonds; 76% of rapists reported avoidant parental attachments and 62% of child sexual abusers reported anxious parental attachments. CONCLUSIONS: Findings from this study support the role of specific developmental experiences as etiological factors in differential sexual offending. Child sexual abusers' developmental histories were characterized by heightened sexuality; whereas rapists' childhood histories were more indicative of violence. These findings have implications for the treatment of sexual abusers and the prevention of sexual abuse. PRACTICE IMPLICATIONS: This study's findings suggest that sexual offenders have been socialized to satisfy human needs of intimacy and sexuality through maladaptive means, which implies that a risk management approach may not be sufficient treatment. Although risk models teach offenders skills to avoid high-risk situations, they fail to address the maladaptive strategies that they may have developed for satisfying needs. Instead, the focus of treatment should be to equip offenders with the knowledge, skills, and opportunities to achieve these needs in an acceptable manner. Thus, this model will provide these individuals with the opportunity to live a healthy life without sexual offending.     

Assessing the interrelatedness of multiple types of adverse childhood experiences and odds for poor health in South Carolina adults

Adverse childhood experiences (ACEs) have been linked to negative health outcomes in adulthood, but little research has been done on the effect of ACEs on the health and well-being of adults in South Carolina (SC). This study analyzed a sample of 9744 respondents who participated in the 2014 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) to examine the relationship among childhood experiences of physical, sexual, and emotional abuse, as well as witnessing household violence, on mental and physical health outcomes in adulthood among SC residents. Twenty-two percent of survey respondents reported poor general health (22.1%), and a smaller proportion reported high frequent mental distress in the past month (13.1%). Each category of childhood experiences was associated with an increase in the risk of poor general health. Individuals reporting three or more types of experiences were more likely to report poor health (aOR 2.89; 95% CI 2.86–2.92) than adults without such experiences. Respondents reporting three or more types of childhood adverse experiences were more likely to report frequent mental distress (aOR 3.29; 95% CI 3.26–3.33) compared to adults who did not report three or more types of adversity. Findings from the SC BRFSS highlight a connection between ACEs and negative health outcomes later in life. Given that results of this study also demonstrated that increased exposure to ACEs was associated with greater odds of negative health in adulthood, preventing adverse events such as experiencing abuse or witnessing domestic violence in childhood will have significant effects on later adult health.     

A comparison between girls' and boys' experiences of unwanted sexual behaviour in secondary schools

Background

This study examines gender differences (and similarities) in the context, meaning and effects of unwanted sexual behaviour in secondary schools.

Purpose

First, the study's purpose is exploration of variables that discriminate between girls' and boys' experiences of unwanted sexual behaviour. Secondly, the aim is to find empirical grounding for diversity in schools' interventions and policies.

Sample

Respondents were 2808 adolescents (14 or 15 years of age) in secondary schools, randomly selected in two regions in The Netherlands. Of the 22 schools that participated in the project, 30% were Catholic, 25% Protestant, 11% interdenominational (several religions within one school) and 38% of the schools were public schools. School size varied. The majority of the students' parents were born in The Netherlands (86%), 14% were born in Morocco, Turkey and Surinam.

Design and methods

Survey questionnaires were to be completed during class time. Non-response rate: 2%. Analysis: discriminant function analysis.

Results

Girls more often experienced unwanted sexual behaviour by school personnel than boys. Their experiences were more often non-verbal in nature, physical or a combination of different sorts of behaviour. Girls experienced unwanted sexual behaviour as more upsetting than boys and they also experienced more psychosomatic health problems. The typical form of boys' experiences of unwanted sexual behaviour was verbal harassment by peers. The behaviour was less upsetting to boys and they experienced less psychosomatic health problems than girls.

Conclusions

This study was the first attempt to find out whether girls' and boys' scores on several variables form a different type of unwanted sexual behaviour. Two different types of unwanted sexual behaviour were found. Although the context (locations and the presence of others) was more or less the same for both sexes, the meaning and the effects of unwanted sexual behaviour were clearly different for girls and boys.     

Abuse and deliberate self-poisoning in women: a matched case-control study.

OBJECTIVE: Controlled studies have shown deliberate self-harm to be more common in abused populations, but no controlled studies have shown abuse to be more common in self-harming populations. This is the first controlled study to determine whether abuse experiences (sexual, physical, and psychological) occurred more commonly in women who take overdoses than in controls. METHOD: The design was a matched (1:1) case-control study set in a district general hospital in England. The subjects were 36 women admitted following deliberate self-poisoning. They were matched with the next non-overdose admission to the same hospital on six variables (sex, age, ethnicity, social class, marital status, and geographical locality). The main outcome measures used were modified versions of standardized self-report questionnaires of sexual, physical, and psychological abuse, together with measures of parenting style and general psychopathology. RESULTS: Women who had taken an overdose were more likely (odds ratio 15.0, 95% confidence interval 2.0 to 113.6) to have been sexually abused, and somewhat more likely to have been psychologically (1.02, 1.00 to 1.05) but not physically abused. They also had higher measures of psychopathology (GHQ-30: 1.19, 1.07 to 1.31), were more likely to have been abused at a younger age, exposed to the "affectionless control" style of parenting by their mothers, and to have harmed themselves in other ways. CONCLUSIONS: The management of women presenting to hospital after self-poisoning should include assessment of abuse experiences, and instigation of appropriate treatment in those with significant sequelae of abuse.     

Sexual Assault Is Just the Tip of the Iceberg: Relationship and Sexual Violence Prevalence in College Students

With the advent of the “Dear Colleague” letter in 2011, higher education institutions have become focused on sexual assault and related policies, procedures regarding offenses, and prevention education. Institutions should consider using this spotlight on interpersonal dynamics to increase awareness about other types of relationship violence that may be more common. This secondary data analysis of 72,067 U.S. college students indicates stalking, emotional abuse, and physical abuse are very common. Along with relationship difficulties in general, these forms of relational violence occur more frequently than sexual assault. Implications for counseling and mental health services are provided.