Gender differences in the association between childhood sexual abuse and risky sexual behaviours: A systematic review and meta-analysis

This meta-analytic review examines the association between childhood sexual abuse and risky sexual behaviours with sub-group analyses by gender. Systematic searches of electronic databases including MEDLINE, PubMed, EMBASE, and PsycINFO were performed using key terms. We used a priori criteria to include high quality studies and control for heterogeneities across eligible studies. The review was registered with PROSPERO and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final meta-analysis applied fixed-effects model to generate pooled odds ratio (OR). Subgroup analyses were conducted to identify potential methodological moderators. The meta-analysis included 8 eligible studies (N = 38,989, females = 53.1%). The overall syndemic of risky sexual behaviors at adulthood was 1.59 times more common in childhood sexual abuse victims. There was a similar association between childhood sexual abuse in general and subsequent risky sexual behaviors in both females and males. However, in cases of substantiated childhood sexual abuse, there was a greater odds of risky sexual behaviors in females (OR = 2.72) than males (OR = 1.69). The magnitude of association of childhood sexual abuse and risky sexual behaviors was similar for males and females regardless of study time, study quality score and method of childhood sexual abuse measurement. There were nonsignificant overall and subgroup differences between males and females. Childhood sexual abuse is a significant risk factor for a syndemic of risky sexual behaviors and the magnitude is similar both in females and males. More research is needed to explore possible mechanisms of association.     

Childhood sexual abuse among university students in Tanzania

OBJECTIVES: There are no prevalence data for childhood sexual abuse among Tanzanian university students. This investigation addressed this paucity. The nature of sexual abuse was also investigated. METHOD: Participants (N=487) from a university in Tanzania completed a questionnaire which assessed abusive childhood sexual experiences, gathering information about age of victim, duration of abuse, perpetrators, amount of force or persuasion involved, and potential causes of child sexual abuse. A number of individuals were also interviewed about their experiences. RESULTS: The overall prevalence rate for child sexual abuse was 27.7%, with rates being higher for females than for males. The average age of the victim when abuse occurred was 13.8 years. Perpetrators were generally unidentified by respondents; nonetheless, a surprisingly high proportion of female perpetrators was noted. There was a considerable amount of force or persuasion involved in the abusive behavior: betrayal of trust, bribes and physical force were cited frequently. Poverty and superstition were the primary explanations given for child sexual abuse. CONCLUSION: The study provides evidence for the existence of child sexual abuse in Tanzania. Poverty feeds the "sugar daddy/mammy" phenomenon and combined with various forms of superstition is an important factor in child sexual abuse in Tanzania.     

Childhood disclosure of sexual abuse and mental health outcomes in adulthood: Assessing merits of early disclosure and discussion

BackgroundEmpirical research on the impact of early disclosure of child sexual abuse (CSA) on survivor health is limited and mixed. One recent study found that early disclosure may actually be detrimental for abuse cessation and adult symptomatology (Swingle et al., 2016). The current study re-examined the effects of early disclosure and related variables on long-term mental health for men with histories of CSA.ObjectiveThe primary aims of this study were to: a) investigate whether early disclosure and response to early disclosure were related to mental distress in adulthood, and b) examine whether having an in-depth discussion and timing of that discussion were related to mental distress in adulthood.Participants and settingData were collected from a large, non-clinical sample of male survivors (N = 487), ranging in age from 19 to 84 years, through an online, anonymous survey.MethodsHierarchical regression analyses were conducted by entering groups of variables in four steps: control variables, CSA severity, disclosure, and discussion.ResultsOverall, models explained between 24–28% of the variance in mental distress. None of the CSA severity variables reached significance. Both early disclosure (β = −0.126, p = 0.003) and response to first disclosure (β = −0.119, p = 0.006) were significant protective factors in Model 3. In the final model, having an in-depth discussion (β = −0.085, p = <0.036) and years until discussion (β = 0.102, p = 0.029) were also related to mental distress.ConclusionsResults support the merits of early disclosure and discussion on long-term mental health. Implications for future research and practice are presented.     

Childhood experience of sexual abuse among Hong Kong Chinese college students

OBJECTIVES: This study aimed to explore the prevalence rate and profiles of abusers and victims of child sexual abuse in a Chinese society. METHOD: A convenience sample of 2,147 Hong Kong Chinese college students completed questionnaires which included items on definitions of child sexual abuse, recall of sexual abuse experience before age 17, information about the sexual abuse incidents, and personal demographics. RESULTS: The overall prevalence rate for various forms of child sexual abuse was 6%, with the rates being higher for females than for males. The average age of the victims at the time of the sexual abuse was 11 years old, with a majority of them experiencing sexual abuse during their teenage years. The average age of the abusers as estimated by the victims was 24 years old, and only 28% of the abusers were strangers to the victims. Males were about three times more likely than females to be sexually abused by their friends, whereas females were about twice more likely than males to be sexually abused by strangers. Only 39% of the victims reported their sexual victimization to others, and 56% of the reported incidents were not followed up. CONCLUSIONS: As compared to Western studies, the present study showed lower rates for more intimate or severe forms of child sexual abuse. The Chinese victims were more reluctant to disclose their sexual victimization than their Western counterparts. Limitations and practical implications of the study are also discussed.     

Childhood disclosure of sexual abuse: Necessary but not necessarily sufficient

Prevention programs often encourage sexually abused children to disclose without fully considering the potential for adverse consequences. This study examined the impact of disclosure on abuse cessation and later adult symptomatology. A clinical sample of 301 adult survivors completed the Impact of Event Scale (IES/IES-R), and the Beck Depression Inventory (BDI-II). Participants were divided into 3 groups: Nondisclosure (n = 221), Disclosure/Abuse Ended (n = 25), and Disclosure/Abuse Continued (n = 55). Multivariate analyses of covariance, adjusting for abuse characteristics (age of onset, penetration, and number of perpetrators) and other trauma exposure, revealed significant differences in psychiatric symptom severity among the three groups, Wilks’ λ = 0. 95, F (6, 584) = 2.69, p = 0.014, η_p² = 0.03. Specifically, those in the Disclosure/Abuse Continued group scored significantly higher on the IES/IES-R Intrusion subscale (p = 0.04) and the BDI-II (p = 0.01), as compared to the Nondisclosure group. The Disclosure/Abuse Ended group did not differ significantly from the other groups. Results suggest that disclosure may be detrimental unless adequate steps are taken to ensure abuse cessation and appropriate treatment.     

Childhood sexual experiences with an older partner among men who have sex with men in Buenos Aires,Argentina

This study sought to describe childhood sexual experiences with older partners (CSEOP) among men who have sex with men (MSM) in Buenos Aires, Argentina. MSM were recruited through respondent driven sampling. They responded to a computer administered self-interview with questions on CSEOP, operationalized as manual, oral, genital, or anal contact prior to age 13 with a partner at least 4 years older. Of the 500 respondents, only 25% identified as gay. Eighteen percent of the respondents reported CSEOP, the majority of whom did not feel they were hurt by the experience and did not consider it to be childhood sexual abuse (CSA). Over two-thirds of MSM who reported CSEOP said that their older partner was a female. Only 4% of those with a female partner felt their experience was CSA compared to 44% of those who had a male partner. Among all men reporting CSEOP, those who felt sexually abused were more likely to have been physically forced or threatened, physically hurt, and emotionally hurt than those who did not feel sexually abused. Having CSEOP, being hurt by the experiences, and perceiving the experiences as sexual abuse were not associated with current HIV sexual risk or substance use behavior. In this sample of MSM in Argentina, a substantial minority reported CSEOP. Those who felt they had been sexually abused were much more likely to have had an older male partner than an older female partner, and were more likely to report having been physically forced and threatened by their older partner.     

Childhood sexual abuse is significantly associated with subsequent sexual offending: New evidence among federal correctional clients

BackgroundAdverse childhood experiences are associated with multiple negative behavioral outcomes and childhood sexual abuse (CSA) is particularly damaging. There is controversial evidence that CSA has a specialized effect on subsequent sexual offending.ObjectiveThe current study tested the hypothesis that CSA is associated with sexual offending.MethodUsing a near-population of correctional clients on supervised release in the Midwestern United States, we examined the hypothesis with hierarchical negative binomial regression models.ResultsCSA was significantly associated with official charges for rape/sexual abuse despite controls for sex, race, age, arrest onset, total arrest charges, total adverse childhood experiences, Antisocial Personality Disorder, sexual sadism, and pedophilia. Age of onset of CSA was also inversely associated with sexual offending with effect sizes ranging between 2–5 standardized z-scores.ConclusionThe current study provides significant evidence that CSA is associated with later sexual offending even when accounting for powerful clinical and criminological covariates.     

Childhood sexual abuse and attachment insecurities as predictors of women's own and perceived-partner extradyadic involvement

We examined the association between self-reported childhood sexual abuse and a woman's own and perceived-partner extradyadic involvement (EDI). The association was examined both directly and as potentially mediated by attachment-related anxiety and avoidance in a sample of 807 French Canadian women. In line with our hypotheses, we found that a personal history of CSA is associated with a woman's own and perceived-partner EDI and with the woman's levels of attachment anxiety and avoidance. The association between CSA and own EDI was partially mediated by attachment-related avoidance. The results suggest that a sense of betrayal stemming from CSA predisposes a woman to avoidance, which in turn predisposes her to EDI. The association between CSA and perceived-partner EDI was partially mediated by both attachment anxiety and avoidance. These results suggest that victims of CSA become suspicious of others’ relational behavior and intentions, which contribute to attachment-related anxiety and avoidance and both own and perceived-partner EDI.     

Childhood sexual victimization,pedophilic interest,and sexual recidivism

Objective

The goal of the current study was to examine the extent to which child sexual abuse (CSA) and particular characteristics of CSA are associated with pedophilic interest and sexual recidivism.

Methods

Subjects were 462 adult male sexual offenders who had been incarcerated in Canadian federal prisons.

Results

Compared to sexual offenders who had not been sexually abused, those who had been sexually abused before age 16 sexually offended against significantly younger victims and had significantly more indicators of pedophilic interest. This was the case whether we examined self-reported or officially documented CSA. Offenders who had been sexually abused exclusively by a male had significantly more indicators of pedophilic interest than those who had been sexually abused exclusively by a female. These findings are consistent with past research and theory suggesting that CSA may play a role in pedophilia and sexual offending against children. CSA exclusively by a female abuser predicted higher rates of sexual recidivism than abuse by a male or both a male and female abuser. Among offenders with victims 15 years old or younger, a closer relationship between offender and abuser predicted higher rates of sexual recidivism. The relationship between CSA and sexual recidivism was significantly moderated by actuarial risk. More specifically, CSA predicted higher rates of sexual recidivism among higher risk offenders, but CSA did not predict sexual recidivism among lower risk offenders. This novel finding raises the possibility that CSA may play a role in sexual recidivism for some offenders.

Conclusion

If future research replicates this CSA by risk interaction and identifies the constructs and processes involved, CSA may be worth considering in risk assessment and treatment.     

Opportunities and challenges in screening for childhood sexual abuse

Retrospective studies suggest 1 in 4 girls and 1 in 6 boys will experience sexual abuse before 18 years of age, resulting in future morbidity. Successful interventions exist, however, victims are reluctant to disclose. Screening for childhood sexual abuse (CSA) may provide an opportunity to overcome this barrier, yet no current model for universal CSA screening exists. We sought to understand the perspective of key stakeholders on CSA screening through qualitative research. Eight focus groups of 7–10 participants each (n = 62) were conducted from April-September 2016. Stakeholders included school nurses, school teachers, counselors and administrators, pediatric providers, and parents. The interview guide focused on reporting suspected CSA and impressions of a CSA screening tool. Sessions were audiotaped and transcribed. Researchers used qualitative content analysis to develop conceptual categories that related to CSA screening and reporting. Two research team members independently open-coded 20% of the data for interrater reliability (kappa = 0.98) prior to completing the coding process. Three major categories emerged to inform CSA screening. First, early screening (e.g. kindergarten) was preferred. Confidentiality was a concern, specifically privacy in the school-setting. As CSA perpetrators are often known to the child, parental presence in the medical office was also a concern. Finally, refinement of the screening process was discussed starting with routine education on safe touch and defining “normal.” Rather than direct questioning, consistent and repeated offering of opportunities to disclose CSA and identification of a trusted adult were suggested. Next steps should involve partnering with evidence-based CSA prevention programs to incorporate and evaluate the aforementioned elements.     

Epidemiologic variations in childhood sexual abuse

We retrospectively reviewed records of 566 children ranging from 6 months to 16 years of age who presented to a sexual assault crisis center. They represented 33.2% of all alleged sexual assault victims seen over a 36 month period. There were 103 males (18.2%) and 463 females (81.8%). Significant differences in presentation were demonstrated with respect to the victim's age, sex, and race, but the major factor influencing the variation is the victim/assailant relationship. Younger children were more likely than older children to present with histories of multiple assaults (p less than .0005), by known assailants (p less than .0005), occurring in the child's or assailant's home (p less than .001) and to report less violence (p less than .05). More risk of violence (p less than .0005) or evidence of trauma (p less than .0005) and less reporting of home assaults (p less than .0005) or multiple assault episodes (p less than .0005) were found in assaults by strangers when compared with non-stranger assaults. A lower frequency of reporting was found in females between 7 and 11 years of age. The dynamics of childhood sexual abuse are discussed in relationship to these findings. A number of victim and assailant related factors determine reporting patterns of childhood sexual abuse.     

Child sexual abuse and its relationship with health risk behaviors among rural children and adolescents in Hunan, China

Objective

The current study was designed to explore the prevalence of child sexual abuse (CSA) and its association with health risk behaviors (i.e., smoking, alcohol use, binge drinking, suicidal ideation, and suicide attempt) among rural children and adolescents in China.

Methods

A sample of 683 rural children and adolescents (8 to 18 years of age) completed an anonymous questionnaire which assessed experiences of CSA and 5 health risk behaviors. Data on several potential confounding factors were also collected.

Results

A total of 123 (18%) respondents reported experiencing at least 1 kind of CSA before 16 years of age, with more boys reporting CSA than girls (21.5% vs. 14.2%). In addition, attending non-boarding schools, lower levels of self-esteem, and higher levels of perceived peer pressure for engagement in health risk behaviors were associated with higher rates of CSA. Multivariate logistic regression analyses revealed that CSA experience was significantly associated with cigarette smoking (aOR = 2.14), binge drinking (aOR = 2.68), suicidal ideation (aOR = 1.69), and suicide attempt (aOR = 2.69) after controlling for several demographic and psychological factors.

Conclusion

More attention should be paid to the issues of CSA among rural children and adolescents in China. Effective CSA prevention intervention needs to address the vulnerabilities of the population, increase children's and parents’ awareness of CSA and ability of self-protection.     

Revisiting the link between childhood sexual abuse and adult sexual aggression

BackgroundChildhood maltreatment poses a risk factor for adult sexual aggression among men.ObjectiveEfforts were made to examine links between childhood sexual abuse (CSA) and sexual aggression after controlling variance associated with other forms of abuse.Participants and settingThis sample was comprised of men (n = 489) who completed a national survey regarding their history of possible abuse and/or sexual aggression.MethodsMaltreatment indices included CSA, parental and sibling physical abuse, exposure to domestic violence, peer bullying, and family emotional abuse. Self-report indicators of sexual frotteurism, coercion and rape were provided by the Sexual Experiences Survey–Short Form Perpetration.ResultsCSA links with the criterion indicators were relatively stronger (r = 0.36, d = 0.65, p < .001) than those found for non-sexual forms of abuse. CSA accounted for unshared variance in sexual aggression with these effects magnified by the addition of parental physical abuse (d = 2.1) or exposure to domestic violence (d = 2.2). The relative risks of prior acts of rape were elevated by CSA (RR = 4.39, p < .001), parental physical abuse (RR = 3.85, p < 0.001), exposure to domestic violence (RR = 3.81, p < .001), or sibling physical abuse (RR = 2.56, p = 0.007). These risks of completed rape were higher as well among respondents polyvictimized by two (RR = 4.92, p < .001) or more (RR = 8.94, p < 0.001) forms of abuse.ConclusionsMultiple forms of child maltreatment, particularly CSA, were strongly associated with adult sexual aggression in this sample of men from the general population.     

Gendered pathways from child sexual abuse to sexual aggression victimization and perpetration in adolescence and young adulthood

This study aimed to examine the pathways from child sexual abuse to sexual assault victimization and perpetration in adolescence and early adulthood, considering risky sexual behavior and lowered sexual self-esteem as mediator variables. In a two-wave longitudinal study with 2251 college students in Germany, male and female participants provided reports of sexual aggression victimization and perpetration since age 14 (T1) and again a year later (T2), covering the last 12 months. In addition, child sexual abuse (CSA; before the age of 14), risky sexual behavior, and sexual self-esteem were assessed at T1, and risky sexual behavior and sexual-self-esteem were assessed again at T2. Experience of CSA was significantly associated with greater likelihood of sexual aggression victimization and perpetration, lower sexual self-esteem, and more risky sexual behavior in both gender groups at T1 and was directly related to victimization at T2 among male participants. In both gender groups, CSA indirectly contributed to a higher probability of sexual victimization at T2 via its impact on victimization T1. In males, the indirect path from CSA to T2 perpetration via T1 perpetration was also significant. Through its negative impact on sexual self-esteem, CSA indirectly increased the probability of sexual victimization among women and the probability of sexual aggression perpetration among men. Risky sexual behavior mediated the pathway from CSA to sexual victimization at T2 for men and women and the pathway from CSA to sexual aggression perpetration for women. The findings contribute to the understanding of gendered effects of CSA on revictimization and the victim-to-perpetrator cycle.     

Adverse childhood experiences,chronic diseases,and risky health behaviors in Saudi Arabian adults: A pilot study

Adverse childhood experiences (ACEs) have been linked with risky health behaviors and the development of chronic diseases in adulthood. This study examined associations between ACEs, chronic diseases, and risky behaviors in adults living in Riyadh, Saudi Arabia in 2012 using the ACE International Questionnaire (ACE-IQ). A cross-sectional design was used, and adults who were at least 18 years of age were eligible to participate. ACEs event scores were measured for neglect, household dysfunction, abuse (physical, sexual, and emotional), and peer and community violence. The ACE-IQ was supplemented with questions on risky health behaviors, chronic diseases, and mood. A total of 931 subjects completed the questionnaire (a completion rate of 88%); 57% of the sample was female, 90% was younger than 45 years, 86% had at least a college education, 80% were Saudi nationals, and 58% were married. One-third of the participants (32%) had been exposed to 4 or more ACEs, and 10%, 17%, and 23% had been exposed to 3, 2, or 1 ACEs respectively. Only 18% did not have an ACE. The prevalence of risky health behaviors ranged between 4% and 22%. The prevalence of self-reported chronic diseases ranged between 6% and 17%. Being exposed to 4 or more ACEs increased the risk of having chronic diseases by 2–11 fold, and increased risky health behaviors by 8–21 fold. The findings of this study will contribute to the planning and development of programs to prevent child maltreatment and to alleviate the burden of chronic diseases in adults.     

大学生陛科学教育内容的探讨

通过选择适当的性科学教育内容帮助大学生学习性生理和性心理等科学知识,加深对人类性本质的理解,建立正确的性价值观,使大学生拥有健康的性意识和性道德,促进他们身心的健康发展。     

Childhood trauma levels in individuals attending adult mental health services: An evaluation of clinical records and structured measurement of childhood trauma

Despite an increased awareness regarding the prevalence and impact of childhood trauma, especially childhood sexual abuse (CSA), few studies examine the clinical reporting of such childhood experiences. This study compared the prevalence of childhood trauma recorded in individual's clinical notes to those ascertained with a structured validated questionnaire, examined which forms of childhood trauma were less likely to be reported to the treating mental health team and established which demographic or clinical factors were associated with reporting of childhood trauma. The prevalence of childhood trauma was ascertained using both the Childhood Trauma Questionnaire (CTQ) and a lifetime retrospective clinical note review in 129 individuals attending a general adult mental health service. Individuals were evaluated for the presence of mental health disorders, impulsivity, symptom severity and disability. Using the CTQ, childhood trauma was noted in 77% of individuals and recorded in 38% of individual's clinical notes (p < 0.001). The greatest differences between CTQ reporting and clinical note documentation were noted for emotional neglect (62% versus 13.2%), physical neglect (48.1% versus 5.4%) and CSA (24.8% versus 8.5%). Childhood trauma was associated with increased psychopathology and greater symptom severity, and was particularly prevalent for individuals with personality disorders. This study demonstrated high rates of childhood trauma amongst adults attending a general adult mental health service. Furthermore, we demonstrated high rates of either non-enquiry from mental health professionals and/or high rates of non-documentation of childhood trauma by mental health professionals. Given the disparity between reporting of childhood trauma in clinical notes and findings with the CTQ, the use of a standardised questionnaire for the assessment of childhood trauma should be considered when performing a comprehensive mental health history.     

Characteristics of victims and perpetrators of intrafamilial sexual abuse

BackgroundIntrafamilial sexual abuse (SA) is one of the most traumatic experiences a person can experience and comes with lifelong effects. Considering the increase in the number of children in orphanages due to intrafamilial SA in Turkey, addressing this problem in more detail is crucial. For this reason, this study aims to determine the characteristics of intrafamilial SA cases.MethodIn this study, the characteristics of 216 intrafamilial SA cases who were referred to the Ankara Child Advocacy Center between 2010 and 2015 were analyzed retrospectively. The ages of the victims varied between 3 and 17.ResultsThe most common identity of the perpetrator was the biological father (50%), biological sibling (14.4%), stepfather (13.9%), and parent’s boyfriend (12%). Of the perpetrators, 6.5% were female and 93.5% were male. Of the victims, 3.3% had a history of pregnancy. In addition, one out of four victims (27.3%) had experienced physical violence from their parents, the socioeconomic level of the majority of the families (90.2%) was low, the education levels of their parents were low (high-school-level education and below), and one of two families (52.6%) experienced domestic violence. Furthermore, the perpetrators in the biological intrafamilial SA group exhibited similar behavior with the sociolegal group in terms of penetration, and the age distribution of the victims was similar.ConclusionsConsequently, this study has revealed a lot of new information about intrafamilial SA cases. These findings will hopefully be useful in identifying and preventing victims at risk for intrafamilial SA.