Exposure to childhood sexual and physical abuse and adjustment in early adulthood

OBJECTIVE: This research examined linkages between exposure to childhood sexual abuse (CSA) and childhood physical punishment/abuse (CPA) and mental health issues in early adulthood. METHOD: The investigation analyzed data from a birth cohort of over 1,000 New Zealand young adults studied to the age of 25. RESULTS: Exposure to CSA and CPA was associated with increased risks of later mental disorders including depression, anxiety disorder, conduct/anti-social personality disorder, substance dependence, suicidal ideation, and suicide attempts at ages 16-25. Control for social, family, and individual factors reduced the associations between CPA and mental health outcomes to the point of statistical non-significance. However, there was a consistent finding for CSA to remain associated with increased risks of later mental health problems. After adjustment, those exposed to CSA including attempted or completed sexual penetration had rates of disorder that were 2.4 times higher than those not exposed to CSA. Those exposed to harsh or abusive physical punishment had rates of disorder that were 1.5 times higher than those exposed to no or occasional physical punishment. It was estimated that exposure to CSA accounted for approximately 13% of the mental health problems experienced by the cohort. Findings showed that exposure to CPA had only weak effects on later mental health. It was estimated that exposure to CPA accounted for approximately 5% of the mental health problems experienced by the cohort. CONCLUSIONS: Exposure to CSA was associated with consistent increases in risks of later mental health problems. Exposure to CPA had weaker and less consistent effects on later mental health. These findings suggest that much of the association between CPA and later mental health reflects the general family context in which CPA occurs, whereas this is less the case for CSA.     

Nine years after child sexual abuse

OBJECTIVE: During 1988-1990, 103 children presented to Child Protection Units (CPU) at two children's hospitals in Sydney, Australia. Nine years later, the psychological adjustment of these young people (mean age=19.1 years, SD=3.4 years; range=14-25 years) was compared with that of non-abused young people of similar age and gender to assess group differences and examine potential risk factors. METHOD: At intake, data on the nature of the index sexual abuse, demographics and the family environment were collected by clinicians. A comparison group, of similar age and gender, was selected from schools in the catchment area of the CPUs. Six years after presentation for the abuse, records of the statutory child protection authority were checked to determine any further notifications for abuse and/or neglect. Nine years after intake, 49 of the abused young people and 68 of the non-abused young people and/or their parents were interviewed and assessed. RESULTS: The sexually abused young people performed more poorly than non-abused young people on psychometric tests of depression (p=.001), self-esteem (p<.001), anxiety (p<.001), behavior (Child Behavior Checklist: p=.01; Youth Self Report: p=.01; Young Adult Self Report: p<.001), and despair (p=.001). They were also more likely to have a history of bingeing (p=.002), self-inducing vomiting (p=.02), smoking cigarettes (p=.01), and using amphetamines (p=.002), ecstasy (p=.002) and cocaine (p=.004). Potential risk factors were in two groups, family and child. Family factors: family functioning, parental drug/alcohol problems, mother's sexual abuse history, mother's depression and socio-economic status. Child factors: despair and hopefulness, number of negative life events, ratings of their father's care, previous notifications for child sexual abuse and placements in out-of-home care by the statutory child protection authority. In the presence of other risk factors, child sexual abuse was a significant predictor of self-esteem, behavior and bingeing. CONCLUSIONS: Rather than focusing only on the individual's child sexual abuse, treatment may also need to address the family's functioning and the individual's feelings of despair.     

Predictors of adult quality of life for foster care alumni with physical and/or psychiatric disabilities

INTRODUCTION: This study used quality of life and resilience as theoretical frameworks for evaluating predictors of outcomes for adults who received foster care services alumni of foster care and were diagnosed with a physical or psychiatric disability while in foster care. METHOD: First, outcomes for foster care alumni with and without physical and psychiatric disabilities (N=1,087) were compared according to quality of life variables. Second, using only participants with disabilities (N=578), stepwise regression analyses were performed to determine whether risk and protective factors were associated with specific outcomes. RESULTS: Alumni with disabilities had significantly lower economic (p=.020) and health (p=.001) outcomes; and reported lower educational attainment (p=.002), more difficulty paying monthly bills (p=.026), more psychiatric diagnoses (p=.006), lower self-esteem (p=.013), and worse physical health (p=.001) than those without disabilities. For alumni with disabilities, receiving special education services and experiencing sexual abuse while in foster care were significant risk factors for poor self-esteem; conversely, receiving services and resources that prepared foster care alumni for leaving foster care (e.g., protective factors) predicted better outcomes. CONCLUSIONS: By expanding the quality of life outcomes analyses to investigate the impact of risk and protective factors on outcomes of foster care alumni with disabilities, this study fills a gap in the literature by assessing outcome differences within the foster-care population. The study found protective factors were associated with more educational attainment and higher self-esteem in adulthood. Conversely, those who received special education services and experienced sexual abuse while in foster care may be at the greatest risk of poor self-esteem and therefore, could benefit from services that enhance self-esteem.     

Men's self-definitions of abusive childhood sexual experiences, and potentially related risky behavioral and psychiatric outcomes

OBJECTIVES: To estimate how many heterosexual and gay/bisexual men self-define abusive childhood sexual experiences (CSEs) to be childhood sexual abuse (CSA) and to assess whether CSA self-definition is associated with risky behavioral and psychiatric outcomes in adulthood. METHODS: In Philadelphia County, 197 (66%) of 298 recruited men participated in a telephone survey. They were screened for CSEs and then asked if they self-defined abusive CSEs to be CSA; they also were asked about risk behavior histories and post-traumatic stress disorder (PTSD) and depression symptoms. RESULTS: Of 43 (22%) participants with abusive CSEs, 35% did not and 65% did self-define abusive CSEs to be CSA ("Non-Definers" and "Definers," respectively). Heterosexual and gay/bisexual subgroups' CSA self-definition rates did not significantly differ. When self-definition subgroups were compared to those without CSEs ("No-CSEs"), Non-Definers had lower perceived parental care (p=.007) and fewer siblings (p=.03), Definers had more Hispanics and fewer African Americans (p=.04), and No-CSEs had fewer gay/bisexual men (p=.002) and fewer reports of physical abuse histories (p=.02) than comparison groups. Non-Definers reported more sex under the influence (p=.001) and a higher mean number of all lifetime sex partners (p=.004) as well as (only) female sex partners (p=.05). More Non-Definers than Definers reported having experienced penetrative sex as part of their CSA (83% vs. 35%, p=.006). Different explanations about self-definition were provided by subgroups. CONCLUSIONS: Many men with abusive CSEs do not self-define these CSEs to be CSA, though not in a way that differs by sexual identity. The process by which men self-define their abusive CSEs to be CSA or not appears to be associated not only with self-explanations that differ by self-definition subgroup, but also with behavioral outcomes that impart risk to Non-Definers.     

Effects of Problem-Based Learning on Recognition Learning and Transfer Accounting for GPA and Goal Orientation

Conflicting research results have stirred controversy over the effectiveness of problem-based learning (PBL) compared to direct instruction at fostering content learning, particularly for novices. We addressed this by investigating effectiveness with respect to recognition learning and transfer and conducting an aptitude-treatment interaction analysis. We also examined how students' goal orientations may moderate learning in PBL and lecture/discussion environments. Participants included 197 preservice teachers in an undergraduate educational psychology course. Controlling for GPA, students in the PBL condition performed significantly better than students in the lecture/discussion condition on a transfer measure (p <.001, partial η² =.271) and equally on a recognition learning measure (p =.530). We also found an aptitude-treatment interaction for recognition learning (p =.012, partial η² =.034) but not transfer (p =.088). Results of goal orientation on learning outcomes were inconclusive.     

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.     

Erasing the Scarlet Letter: How Positive Media Messages About Sex Can Lead to Better Sexual Health Among College Men and Women

This study explores how positive media messages about sex can lead to better sexual health among young adults (college students at a large university, N = 228) by de-emphasizing sensation seeking, condom embarrassment, and stigma. Employing social learning theory and normative influence frameworks, the research found that college-age women had higher stigma (β =.22, t = 3.37, p <.001 for felt stigma) and lower sensation seeking (β = –.34, t = ?3.17, p <.01). Participants exposed to more media in some forms (e.g., news reading, β = –.131, t = ?1.94, p =.05) had less felt self-stigma. Thus, exposure to media, such as TV and media, and positive messages could encourage healthy sexual behavior in young women (around college age).     

Sensation seeking and risk-taking propensity as mediators in the relationship between childhood abuse and HIV-related risk behavior

OBJECTIVES: Although a wealth of literature suggests that childhood physical, emotional, and sexual abuse are related to later-life HIV-related risk behaviors, few studies have explored disinhibition (e.g., impulsivity, risk-taking propensity, and sensation-seeking) as a risk factor in this relationship. METHOD: This cross-sectional study examined impulsivity, risk-taking propensity, and sensation seeking as mediators in the relationship between abuse history and engagement in HIV-related risk behaviors among a sample of 96 inner-city African American adolescents. RESULTS: Findings indicated that abuse history was positively related to self-reported engagement in HIV-related risk behaviors (B=.027, SE .008, beta=.32, sr(2)=.105, p=.001), as well as risk-taking propensity (B=.35, SE .11, beta=.30, sr(2)=.090, p=.003) and sensation seeking (B=.17, SE .05, beta=.35, sr(2)=.124, p=.0004). Abuse history was not related to impulsivity. Further, while sensation-seeking and risk-taking propensity (to a lesser extent) mediated this relationship, impulsivity did not. CONCLUSIONS: These findings provide an initial step in the examination of the mechanisms underlying the relationship between childhood abuse and engagement in HIV-related risk behaviors.     

The effect of intra- versus post-interview feedback during simulated practice interviews about child abuse

OBJECTIVE: This study compared the effectiveness of two types of instructor feedback (relative to no feedback) on investigative interviewers' ability to adhere to open-ended questions in simulated practice interviews about child abuse. METHOD: In one condition, feedback was provided at the end of each practice interview. In the other, the instructor stopped the interviewer at various stages during the practice interviews to provide feedback. The relative effect of these conditions was examined by measuring interviewers' performance in a standardized mock interview paradigm immediately prior to, immediately after, and 12 weeks after the practice and feedback sessions. RESULTS: Prior to and 12 weeks after the practice sessions were administered, there was no significant difference in participants' adherence to open-ended questions irrespective of the nature of the feedback, or whether feedback was received. At the immediate post-practice assessment interval, however, the participants who received feedback during the practice interviews performed better (M proportion of open-ended questions=.85, SD=.13) than the other participants (post-interview feedback M=.67, SD=.18, p<.001; no feedback M=.56, SD=.16, p<.001). This heightened use of open-ended questions was associated with a greater tendency among the interviewees to provide abuse-related details in response to open-ended questions (M=.91, SD=.11) compared to the other participants (post-interview feedback M=.77, SD=.15, p<.05; no feedback M=.69, SD=.16, p=.001). CONCLUSIONS: Different types of feedback can be differentially effective in training child abuse investigators to adhere to open-ended questions. The benefits of any training program, however, are likely to be short-lived without ongoing practice. PRACTICE IMPLICATIONS: A single study compared the relative effectiveness of two types of instructor feedback (relative to no feedback) on investigative interviewers' ability to adhere to open-ended questions in simulated practice interviews about child abuse. This research is relevant to trainers of investigative interviewers because there is currently large variability in the type of feedback employed in training programs. This study is one of the first to empirically demonstrate that different types of feedback may be differentially effective in improving the performance of investigative interviewers.     

Interplay between childhood maltreatment, parental bonding, and gender effects: impact on quality of life

OBJECTIVE: The aim of this study was to examine associations between childhood adversity, parental bonding, gender, depressive symptoms, and quality of life in non-treatment-seeking adults from the community. METHOD: Effects of differential parental rearing were compared in adults who reported a high degree of childhood maltreatment (n=72) and those who reported no significant adverse events in childhood (n=69). Subjects completed retrospective measures of childhood maltreatment and perceived parenting style, as well as measures of current depressive symptoms and quality of life. RESULTS: The subjects without childhood maltreatment were younger and endorsed less current depressive symptomatology than did subjects with childhood maltreatment. While the subjects without a history of maltreatment reported more "optimal" bonding experiences with their parents, the maltreatment group members were more likely to characterize their early parental bonding experiences in terms of "affectionless control" (p<.001 for both maternal and paternal parenting), "affectionate constraint" (p=.025 for maternal parenting and p=.004 for paternal parenting), or "weak or absent" bonding (p<.001 for both maternal and paternal parenting). Results of a multiple regression analysis revealed that overall quality of paternal care (p=.015) and current level of depressive symptoms (p<.001) were significant independent predictors of adult quality of life. Gender effects between subjects providing parental bonding data were limited to the group with childhood maltreatment. CONCLUSION: These findings extend previous work documenting a relationship between early life maltreatment and suboptimal parental bonding, suggesting gender-specific effects of maternal and paternal care. Effects of childhood maltreatment on quality of life in adulthood appear to be linked with the quality of childhood paternal care and the occurrence of depressive symptomatology in adulthood, suggesting possible targets for primary or secondary prevention.     

Predicting running away in girls who are victims of commercial sexual exploitation

Youth that are victims of commercial sexual exploitation of children (CSEC) have a host of clinical problems and often run away from home, residential care, and treatment, which complicates and limits treatment effectiveness. No research to date has attempted to predict running away in CSEC victims. The present study aimed to 1) characterize a clinically referred sample of girls who were victims of CSEC and compare them to other high-risk girls (i.e., girls who also have a history of trauma and running away, but deny CSEC); and 2) examine the utility of using the Youth Level of Service/Case Management Inventory (YLS/CMI) to predict future running away. Data were collected from de-identified charts of 80 girls (mean age = 15.38, SD = 1.3, 37.9% White, 52.5% CSEC victims) who were referred for psychological assessment by the Department of Child Services. Girls in the CSEC group were more likely to have experienced sexual abuse (χ² = 6.85, p = .009), an STI (χ² = 6.45, p = .01), a post-traumatic stress disorder diagnosis (χ² = 11.84, p = .001), and a substance use disorder diagnosis (χ² = 11.32, p = .001) than high-risk girls. Moderated regression results indicated that YLS/CMI scores significantly predicted future running away among the CSEC group (β = 0.23, SE = .06, p = .02), but not the high-risk group (β = −.008, SE = .11, p =.90). The YLS/CMI shows initial promise for predicting future running away in girls who are CSEC victims. Predicting running away can help identify those at risk for and prevent running away and improve treatment outcomes. We hope current findings stimulate future work in this area.     

Child maltreatment and perceived family environment as risk factors for adult rape: is child sexual abuse the most salient experience?

OBJECTIVE: Child maltreatment and family functioning were examined as predictors of adult rape in a sample of 925 college women. METHOD: Information was obtained from retrospective self-report questionnaires. Child sexual abuse (CSA) was assessed with the Life Experiences Questionnaire, child emotional abuse (CEA) and physical abuse (CPA) were assessed with the Childhood Trauma Questionnaire, family functioning was assessed with the Family Environment Scale, and adult rape was assessed with the Sexual Experiences Survey. RESULTS: Approximately 17% of women reported a history of any form of child abuse: 8.9% reported CSA, 4.2% reported CPA, and 8.6% reported CEA. Fifteen percent of participants reported a history of rape since age 17. CSA and CEA, but not CPA, were related to adult rape. Experiencing multiple forms of child abuse increased the risk of adult rape. Logistic regression analyses indicated that CSA predicted adult rape (OR=1.9). Further, low levels of family cohesion predicted adult rape only in the absence of CEA (OR=1.2), and low levels of emotional expressiveness in the family predicted adult rape only in the presence of CEA (OR=1.4). CONCLUSIONS: Findings highlight the need to consider multiple forms of child abuse as well as family functioning in relation to the risk of adult sexual victimization. Findings suggest CSA is a risk factor for adult victimization independent of family functioning, and family dysfunction exerts an impact on rape only in relation to CEA.     

Child sexual abuse research knowledge among child abuse professionals and laypersons

The purposes of this study were to: (1) Assess child abuse professionals’ and nonprofessionals’ knowledge of scientific research findings that are relevant to forensic child sexual abuse (CSA) evaluations and (2) describe associations between child abuse professionals’ levels of research knowledge and their education and experience. An 18-item multiple-choice test was administered to 188 child abuse professionals and 457 nonprofessionals (undergraduate college students) in Brazil and the United States. The nonprofessionals’ average percent correct, M = 44%, was not significantly different than what would be expected for random guessing (45%). The professionals’ average percent correct, M = 55%, was higher than that of nonprofessionals and random guessing (both ps < .001). The average percent correct score for the US-sample psychologists, M = 76%, was higher than the average score of the other professionals, M = 51%, p < .001. Professionals’ educational level, as measured by the highest academic degree obtained, was positively associated with percent correct scores, Spearman's ρ = .46, p < .001. Controlling for educational attainment, professional experience, as measured by the total number of CSA evaluations performed, was weakly associated with percent correct scores, partial r = .15, p = .04. Percent correct scores were low for both nonprofessionals and professionals. Most of the participants in this study were uninformed or misinformed about scientific research findings that are important for conducting optimal forensic CSA evaluations and for making accurate judgments about the validity of sexual abuse allegations.     

The role of complex posttraumatic stress symptoms in the association between exposure to traumatic events and severity of intimate partner violence

BackgroundSymptoms of both posttraumatic stress disorder (PTSD) and disturbances in self-organization (DSO) have been suggested to play a role in the association between an individual's childhood physical abuse and neglect and his/her perpetration of IPV in adulthood; however, the two have yet to be studied in one model. Thus, we aimed to examine the interrelations among childhood exposure to violence and physical neglect, exposure to trauma across one's lifetime, ICD-11 CPTSD symptoms (i.e., PTSD and DSO), and IPV severity.MethodsParticipants were 234 men drawn randomly from a national sample of 1600 mandated men receiving treatment for domestic violence in Israel. They completed measures of potentially traumatic exposure, symptoms of CPTSD, child abuse and neglect, and IPV. Structural equation modeling (SEM) was used to examine possible direct and indirect effects of the study variables.ResultsResults confirmed the indirect role of CPTSD symptoms in the association between the following types of traumatic exposure – childhood exposure to violence (B = .03, β = .05, SE = .01, p = .05, CI 90% [.041, .143]), childhood exposure to physical neglect (B = .04, β = .04, SE = .02, p < .01, CI 90% [.014, .092]), and lifetime exposure to potentially traumatic events, or PTEs (B = .04, β = .09, SE = .01, p < .001, CI 90% [.006, .074]) – and the perpetration of psychological IPV as an adult. No significant results were found in relation to the perpetration of physical IPV.ConclusionsThe current cross-sectional study findings suggest a preliminary direction regarding the possible direct and indirect effects of ICD-11CPTSD on the severity of IPV psychological perpetration. The clinical implications include the need to focus on both PTSD and DSO symptoms in order to help reduce these potential risk factors for psychological IPV perpetration.     

Trends in child maltreatment literature

INTRODUCTION: To identify possible gaps in the child maltreatment literature the present study examined the development of the child maltreatment literature over a 22-year period, including temporal trends for child maltreatment types, the characteristics of the research participants, and sources of participant recruitment. METHOD: Child maltreatment articles (N=2090) published from 1977 to 1998 (inclusive) in six specialty journals were coded on type of article, type of child maltreatment, gender and parental status of participants, abuse role of participants, and recruitment source of participants. RESULTS: Across the period studied the annual percentage of quantitative articles (articles with inferential statistics) increased, whereas the annual percentage of theoretical articles decreased. The annual percentage of articles examining child physical abuse (CPA) decreased, whereas the annual percentage of articles examining child sexual abuse (CSA) increased. The percentages of articles examining child neglect (CN) or child emotional abuse (CEA) remained consistently low. Distinguishing child maltreatment types in research articles increased. Males were underrepresented in CPA perpetration and CPA adult victimization articles, but adequately represented in CSA perpetration and CPA child victimization articles. Females were adequately represented in CPA perpetration and CSA child and adult victimization articles. Recruitment from universities and outpatient mental health facilities increased; recruitment from medical settings decreased. CONCLUSIONS: CN and CEA literatures need to be developed first by theoretical, then by quantitative works. In addition, the publication of more research on male subjects for CPA perpetration and adult CPA victimization is needed.     

The link between maltreatment and juvenile firesetting: correlates and underlying mechanisms

OBJECTIVE: Despite the widely held belief that abuse is a risk factor for childhood firesetting, the role of maltreatment in firesetting is largely unexplored. This study reports on a sample of children and adolescents referred to a brief assessment and intervention program for juvenile firesetters. Firesetting histories of maltreated youth were compared to a group of firesetting youth with no maltreatment history. METHODS: Participants included 205 children and youth aged 4-17 years and their caregivers. Assessments were completed with a standardized protocol. Forty-eight percent of the sample had a history of maltreatment as reported by caregivers; 26% of the sample had experienced more than one type of maltreatment. RESULTS: When compared to the non-maltreated group, children with histories of maltreatment demonstrated more frequent fire involvement, more versatility regarding ignition sources and targets, and a greater likelihood of an immediate family stressor as a motive for firesetting (all p<.05). Maltreated children were more likely to become involved with fire out of anger (p=.001), and there was also a trend towards higher rates of recidivism (p=.07). Children's externalizing behavior partially mediated the influence of maltreatment on specific fire-related outcomes of children (OR=1.10; 95% CI=1.04-1.17; p=.001). CONCLUSIONS: Within a juvenile firesetting population, the presence of maltreatment is a risk factor for a more severe course of firesetting. The findings also suggest that the link between maltreatment and firesetting is operating partially through heightened emotional and behavioral difficulties. PRACTICE IMPLICATIONS: This study demonstrates that maltreatment is a risk factor that contributes to a more severe course of juvenile fire involvement, and that the link between maltreatment and firesetting operates largely through heightened behavioral and emotional difficulties. These findings highlight the need for mental health clinicians to (a) be aware that these two serious clinical issues frequently co-occur, (b) screen for fire-related behaviors and maltreatment during general assessments, and (c) consider maltreatment status when thinking about the risk of firesetting.     

Caregiver perceptions of sexual abuse and its effect on management after a disclosure

Objective

The aim of the study was to examine caregiver management strategies for child sexual abuse (CSA) when presented with hypothetical scenarios that vary in physical invasiveness.

Methods

One hundred fifty three caregivers were given 3 scenarios of CSA with 7 management strategies presented in the 21-item Taking Action Strategies (TAS) scale. Caregivers were asked to rate strategies according to their willingness to carry out each action with rating of 5 = greater likelihood of carrying out the action specified while a rating of 1 = a lower likelihood of carrying out that action. CSA scenarios included exposure to pornography/masturbation, fondling, and penetration while management strategies including fighting the accused, blaming the child, and outreaching to the authorities. Repeated measures ANOVA was used to compare mean TAS scores for the management strategies across CSA scenarios.

Results

The difference between TAS scores across the abuse scenarios was statistically significant (p < .001). Mean TAS scores reflected greater preference for taking action if the abusive act was perceived as more physically intrusive (exposure to pornography/masturbation-TAS 3.5, fondling-TAS 3.7, penetration-TAS 3.8). Caregivers reported being less willing to handle a disclosure of CSA without outreach (TAS 2.5 and 2.0 for fighting and blaming the child, respectively) and more willing to manage a disclosure with outreach to authorities (TAS 3.8, 4.5, and 4.7 for outreaching to Child Protective Services [CPS], to the child's healthcare provider and police, respectively). A predictor of caregiver outreach to authorities identified was the caregiver having past interactions with CPS.

Conclusion

Perception of the physical invasiveness of CSA and demographic factors can impact caregiver management strategies after a disclosure.

Practice implications

Results suggest that several factors influence caregiver management of sexual abuse. These factors warrant further study, as they are potential contributors to declining trends in CSA cases observed. Other implications include the need for educational efforts targeting caregivers. These interventions should focus on dispelling myths about the perceived physical invasiveness of CSA. These perceptions should not mitigate a caregiver's decision to involve the authorities in their management after a disclosure. Lastly, despite criticisms of the child protective systems, caregivers with past encounters with CPS view these related agencies as valuable resources.     

The beneficial effect of sleep on behavioral health problems in youth is disrupted by prenatal cannabis exposure: A causal random forest analysis of Adolescent Brain Cognitive Development data

Studies suggest prenatal cannabis exposure is associated with mood/behavioral problems in children. However, it is unclear if targeting modifiable domains like sleep behaviors would improve outcomes in exposed youth. Using a causal inference framework, the effect of changing sleep-hours on changing internalizing/externalizing problems in children was examined using the Adolescent Brain Cognitive Development™ study baseline (ages 9–10; collected during 2016–2018) and year-1 follow-up data (N = 9825; 4663 female; 5196 white). Average treatment effects (ATE) indicated that more sleep predicted less internalizing (ATE = −.34, SE = .08, p < .001) and externalizing (ATE = −.29, SE = .07, p < .001) problems over time. However, prenatal cannabis exposure moderated the ATE on internalizing (conditional-ATE = .91, SE = .39, p = .019), whereby participants with exposure (n = 605) did not show any effect of changing sleep-hours on mood (B = .09, SE = .24).     

Body mass index and anxiety/depression as mediators of the effects of child sexual and physical abuse on physical health disorders in women

The relation between childhood sexual abuse (CSA) and physical health disorders in adulthood, and what factors may serve as mediators, remains poorly understood. Using data from the 2007 Adult Psychiatric Morbidity Survey (N = 3,486), we tested whether CSA was associated with physical health disorders in adult women and if mediated effects via body mass index (BMI), anxiety/depression, alcohol dependence, and smoking were present. Compared to women with no CSA, women who had experienced CSA involving intercourse had more than twice the odds of being obese, more than 3 times the odds of experiencing mental health disorders, more than 4 times the odds of being alcohol dependent, more than 5 times the odds of being drug dependent, and more than 6 times the odds of attempting suicide. Those experiencing both CSA and child physical abuse (CPA) were on average over 11 kg heavier than those with neither CSA nor CPA. After controlling for demographics, CPA, and childhood bullying, CSA was associated with the majority of physical health disorders studied (typically 50–100% increases in odds). Evidence was found consistent with mediation by BMI (typically accounting for 5–20% increases in odds) and anxiety/depression (typically accounting for 8–40% increases in odds), in a dose-response manner, for the majority of physical health disorders. Bidirectional relations among these mediators and physical health disorders, and residual confounding, may have led to overestimation of mediation through BMI and anxiety/depression and underestimation of mediation through alcohol/smoking. Relations between both CPA and childhood bullying and physical health disorders in adulthood were also found. Longitudinal studies employing more sensitive measures of potential mediators are now required.