Child Sexual Abuse Mathews, Ben; Collin-Vézina, Delphine
Trauma, Violence, & Abuse,
04/2019, Letnik:
20, Številka:
2
Journal Article, Book Review
Recenzirano
Odprti dostop
The problem of defining “child sexual abuse” (CSA), and the need to define this concept, has been recognized by major policy bodies and leading researchers since the 1970s. Recent demands for a more ...theoretically robust, explicit definition of CSA show this challenge remains urgent. In this article, we identify problems caused by variance in definitions of CSA for five domains: research and knowledge formation, legal frameworks and principles, prevention efforts, policy responses, and the establishment of social norms. We review and analyze definitions used in leading international epidemiological studies, national and international policy documents, social science literature, and legal systems in the United States, Canada, and Australia to demonstrate the continuing use of different concepts of CSA and identify key areas of conceptual disagreement. Informed by our literature review, we use a methodology of conceptual analysis to develop a conceptual model of CSA. The purpose of this model is to propose a more robust, theoretically sound concept of CSA, which clarifies its defining characteristics and distinguishes it from other concepts. Finally, we provide operational examples of the conceptual model to indicate how it would translate to a classificatory framework of typologies of acts and experiences. A sound conceptual model and classificatory system offers the prospect of more appropriate and effective methods of research, response, regulation, and prevention. While total consensus is unattainable, this analysis may assist in developing understanding and advancing more coherent approaches to the conceptual foundation of CSA and its operationalization.
Abstract Responses from N = 60,598 interviews from the 2010 Behavioral Risk Factor Surveillance System (the 10 states and the District of Columbia that included the optional Adverse Childhood ...Experience (ACE) module) were used to test whether associations between childhood adversity and adult mental health and alcohol behaviors vary by race/ethnicity and sex. ACE items were categorized into two types – household challenges and child abuse. Outcomes were current depression, diagnosed depression, heavy drinking and binge drinking. Logistic regression models found ACEs significantly associated with depression and excessive alcohol use, but sex did not moderate any relationships. Race/ethnicity moderated the relationship between ACEs and heavy drinking. In stratified analyses, compared to those not exposed to ACEs, non-Hispanic blacks who experienced either type of ACE were about 3 times as likely to drink heavily; Non-Hispanic whites who experienced child abuse or both ACE types were 1.5–2 times as likely to drink heavily; and Hispanics who experienced household challenges or both ACE types were 1.2 and 11 times as likely to report heavy drinking. ACEs impact depression and excessive alcohol use similarly across men and women. With the exception of heavy drinking, ACEs appear to have the same association with excessive alcohol use across race/ethnicity. It may be prudent to further investigate why the relationship between ACEs and heavy drinking may differ by race/ethnicity such that prevention strategies can be developed or refined to effectively address the needs of all sub-groups.
Abstract Objective To determine if meaningful groups of at-risk pre-adolescent youth could be identified based on their self-report of physical and sexual abuse histories. Methods Youth participating ...in a consortium of ongoing longitudinal studies were interviewed using an audio-computer assisted self-interview (A-CASI) when they were approximately 12 years of age to obtain information about their perceived experiences of physical (18 items) and sexual (12 items) abuse. In addition, Child Protective Service records were reviewed and the taxonomy developed for defining maltreatment characteristics ( Barnett, Manly, & Cicchetti, 1993 ) was applied. A total of 795 youth completed the age 12 interview and had their records reviewed during the period from birth to the time of their age 12 interview. A latent variable modeling approach, specifically latent class analysis (LCA), was used to generate profiles of youth based on their endorsements of the physical and sexual abuse items. These profiles were then compared to CPS reports of physical or sexual abuse to determine their validity. Results The LCA identified 4 interpretable classes or groups of pre-adolescent youth. Based on the pattern of responses to specific items the classes were identified as follows: (1) no physical or sexual abuse; (2) high physical abuse/low sexual abuse; (3) no physical abuse/moderate sexual abuse; and (4) high physical and sexual abuse. Follow-up analyses indicated that the odds of a CPS report for Classes 2, 3, and 4 compared to Class 1 were significantly greater (2.21, 2.55, and 5.10, respectively). Conclusion The latent variable modeling approach allowed for the identification of meaningful groups of youth that accounted for both the occurrence of multiple types of abuse as well as differing severities associated with each type. It is suggested that this methodological approach may be most useful in future efforts to identify the antecedents and consequences of maltreatment. Practice implications The results of the present study not only have implications for future research efforts, but also suggest that in practice, youth at-risk for maltreatment may be reliable and valid reporters of their physical and sexual abuse experiences.
Child maltreatment occurs in the Black community at higher rates than any other racial group. Given the prevalence of child maltreatment risk factors in the Black community, such as being in a ...low-income family, single parent family, greater exposure to physical discipline, and less access to services and resources, it is not surprising but nonetheless concerning that Black children are at greater risk for abuse and/or neglect. Unearthing the cause and effect between the challenges faced by the Black community and the life outcomes for Black children is key to making positive changes happen. Through a feminist and womanist lens, the authors unpack the range of factors that intersect and impact the Black community that are necessary to address to effectively protect Black children. Understanding how to prevent maltreatment and promote health and wellness are essential to adequately address maltreatment so as to protect and empower Black children.
Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of ...the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature.
We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores.
192 unique samples consisting of 68,830 individuals.
We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis.
We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95–1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32–.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations.
These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.
Childhood trauma is an important public health problem, but there are limitations in our ability to measure childhood abuse. The purpose of this study was to develop a self-report instrument for the ...assessment of childhood trauma that is valid but simple to administer. A total of 288 subjects with and without trauma and psychiatric disorders were assessed with the Early Trauma Inventory-Self Report (ETI-SR), an instrument for the assessment of physical, emotional, and sexual abuse, as well as general traumas, which measures frequency, onset, emotional impact, and other variables. Validity and consistency of the ETI-SR using different methods of scoring was assessed. The ETI-SR was found to have good validity and internal consistency. No method was found to be superior to the simple method of counting the number of items endorsed as having ever occurred in terms of validity. Some items were found to be redundant or not necessary for the accurate measurement of trauma severity within specific domains. Subsequent analyses with a shortened checklist of items showed acceptable validity and internal consistency. These findings suggest that the ETI-SR is a valid measure of early trauma, and suggest future directions for a shortened version of the ETI-SR that could be more easily incorporated into clinical research studies and practice settings.
To investigate the association of physical and sexual abuse in childhood and adolescence with risk of adult obesity among black women in the United States.
Participants were women enrolled in the ...Black Women's Health Study, an ongoing prospective cohort study begun in 1995. In 2005, 33298 participants completed a self-administered questionnaire on early life experiences of abuse. Log-binomial regression models were used to derive risk ratios (RRs) and 95% confidence intervals (CIs) for the relation of child/teenager abuse with obesity (BMI ≥ 30) and central adiposity (waist circumference >35 inches) reported in 2005.
The RR for BMI ≥ 30, a measure of overall obesity, was 1.29 (95% CI 1.20-1.38) for the highest severity of exposure to child/teenager physical and sexual abuse relative to no abuse. After controlling for postulated intermediates, including reproductive history, diet, physical activity, depressive symptoms, and socioeconomic status, the RR was 1.14 (95% CI 1.08-1.21). The RR for waist circumference >35 inches, which measures central obesity, for severe physical and sexual abuse relative to no abuse was 1.29 (95% CI 1.19-1.38) before adjustment for intermediates and 1.18 (95% CI 1.10-1.27) after adjustment.
Early life sexual and physical abuse was associated with an increased risk of overall and central obesity in adulthood. Although the association between abuse and obesity was explained to some extent by health behaviors, reproductive history, and mental health, these factors did not fully account for the associations. Our data suggest that early life adversity is related to adult body size and weight distribution.
Background
Childhood maltreatment is the most important preventable cause of psychopathology accounting for about 45% of the population attributable risk for childhood onset psychiatric disorders. A ...key breakthrough has been the discovery that maltreatment alters trajectories of brain development.
Methods
This review aims to synthesize neuroimaging findings in children who experienced caregiver neglect as well as from studies in children, adolescents and adults who experienced physical, sexual and emotional abuse. In doing so, we provide preliminary answers to questions regarding the importance of type and timing of exposure, gender differences, reversibility and the relationship between brain changes and psychopathology. We also discuss whether these changes represent adaptive modifications or stress‐induced damage.
Results
Parental verbal abuse, witnessing domestic violence and sexual abuse appear to specifically target brain regions (auditory, visual and somatosensory cortex) and pathways that process and convey the aversive experience. Maltreatment is associated with reliable morphological alterations in anterior cingulate, dorsal lateral prefrontal and orbitofrontal cortex, corpus callosum and adult hippocampus, and with enhanced amygdala response to emotional faces and diminished striatal response to anticipated rewards. Evidence is emerging that these regions and interconnecting pathways have sensitive exposure periods when they are most vulnerable.
Conclusions
Early deprivation and later abuse may have opposite effects on amygdala volume. Structural and functional abnormalities initially attributed to psychiatric illness may be a more direct consequence of abuse. Childhood maltreatment exerts a prepotent influence on brain development and has been an unrecognized confound in almost all psychiatric neuroimaging studies. These brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity. Their relationship to psychopathology is complex as they are discernible in both susceptible and resilient individuals with maltreatment histories. Mechanisms fostering resilience will need to be a primary focus of future studies.
Childhood maltreatment is the most important preventable cause of psychopathology, accounting for about almost half of the risk for childhood onset psychiatric disorders. A key discovery is that maltreatment alters trajectories of brain development. This review synthesizes neuroimaging findings in children who experienced caregiver neglect, as well as from studies in young people and adults who experienced physical, sexual and emotional abuse. Key findings are that childhood maltreatment is associated with consistent alterations in key regions of the brain and maltreatment is consistently associated with enhanced amygdala response to threatening stimuli and diminished striatal response to anticipated reward. Brain regions and pathways affected are predominantly part of circuits regulating threat detection and reward anticipation, with exposure to single types of abuse associated with specific alterations that convey the aversive experience. These brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity. Their relationship to psychopathology is complex, however, as they are discernible in both susceptible and resilient individuals with maltreatment histories. Future studies will need to focus on mechanisms fostering resilience.
Read the Commentary on this article at doi: 10.1111/jcpp.12540
Abstract Background This study examines the prevalence, correlates, and psychiatric disorders of adults with history of child sexual abuse (CSA). Methods Data were derived from a large national ...sample of the US population. More than 34 000 adults 18 years and older residing in households were interviewed face-to-face in a survey conducted during the 2004-2005 period. Diagnoses were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule– Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, version. Weighted means, frequencies, and odds ratios of sociodemographic correlates and prevalence of psychiatric disorders were computed. Logistic regression models were used to examine the strength of associations between CSA and psychiatric disorders, adjusted for sociodemographic characteristics, risk factors, and other Axis I psychiatric disorders. Results The prevalence of CSA was 10.14% (24.8% in men and 75.2% in women). Child physical abuse, maltreatment, and neglect were more prevalent among individuals with CSA than among those without it. Adults with CSA history had significantly higher rates of any Axis I disorder and suicide attempts. The frequency, type, and number of CSA were significantly correlated with psychopathology. Conclusions The high correlation rates of CSA with psychopathology and increased risk for suicide attempts in adulthood suggest the need for a systematic assessment of psychiatric disorders and suicide risk in these individuals. The risk factors for CSA emphasize the need for health care initiatives geared toward increasing recognition and development of treatment approaches for the emotional sequelae CSA as well as early preventive approaches.
Abstract 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, ηp2 = 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.
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