A history of childhood sexual abuse (CSA) has been associated with adult depression, but data on abuse severity and disclosure are scant, particularly among low income ethnic minorities. CSA often co-occurs with other adversities, which also increase the risk of depression. This study examined the peri-trauma variable of abuse severity and the post-trauma variables of disclosure and self-blame as predictors of current depression symptoms in 94 low-income African American and Latina women with histories of CSA. After controlling for non-sexual childhood adversity and adult burden (i.e., chronic stress), severe CSA overall was associated with higher depression scores, especially among Latinas who disclosed their abuse. Depression symptoms among African American women were highest in those who disclosed and reported high levels of self-blame at the time of the incident. The link between depression and specific peri- and post-CSA factors in minority women may help guide future interventions.
In European and US studies, patients with major depressive disorder (MDD) report more stressful life events (SLEs) than controls, but this relationship has rarely been studied in Chinese populations.
Sixteen lifetime SLEs were assessed at interview in two groups of Han Chinese women: 1970 clinically ascertained with recurrent MDD and 2597 matched controls. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression.
60% of controls and 72% of cases reported at least one lifetime SLE. Fourteen of the sixteen SLEs occurred significantly more frequently in those with MDD (median odds ratio of 1.6). The three SLEs most strongly associated with risk for MDD (OR > 3.0) preceded the onset of MDD the majority of the time: rape (82%), physical abuse (100%) and serious neglect (99%).
Our results may apply to females only. SLEs were rated retrospectively and are subject to biases in recollection. We did not assess contextual information for each life event.
More severe SLEs are more strongly associated with MDD. These results support the involvement of psychosocial adversity in the etiology of MDD in China.
Major depressive disorder; Stressful life event; Social adversity; Symptom
The prevalence of child sexual abuse (CSA) in the population has been poorly described in developing countries. Population data on child sexual abuse in Brazil is very limited. This paper aims to estimate lifetime prevalence of child sexual abuse and associated factors in a representative sample of the population aged 14 and over in a city of southern Brazil.
A two-stage sampling strategy was used and individuals were invited to respond to a confidential questionnaire in their households. CSA was defined as non-consensual oral-genital, genital-genital, genital-rectal, hand-genital, hand-rectal, or hand-breast contact/intercourse between ages 0 and 18. Associations between socio-demographic variables and CSA, before and after age 12, were estimated through multinomial regression.
Complete data were available for 1936 respondents from 1040 households. Prevalence of CSA among girls (5.6% 95%CI [4.8;7.5]) was higher than among boys (1.6% 95%CI [0.9;2.6]). Boys experienced CSA at younger ages than girls and 60% of all reported CSA happened before age 12. Physical abuse was frequently associated with CSA at younger (OR 5.6 95%CI [2.5;12.3]) and older (OR 9.4 95%CI [4.5;18.7]) ages. CSA after age 12 was associated with an increased number of sexual partners in the last 2 months.
Results suggest that CSA takes place at young ages and is associated with physical violence, making it more likely to have serious health and developmental consequences. Except for gender, no other socio-demographic characteristic identified high-risk sub-populations.
Childhood and adolescent sexual abuse (CSA) is associated with a wide variety of adverse psychological and health outcomes, including negative sexual health outcomes. In this paper, we review the literature investigating the relation between CSA and subsequent sexual risk behaviors among men and women. Previous research has found a relatively consistent association between CSA and higher rates of sexual risk behaviors, particularly sex trading, more sexual partners, and an earlier age of first intercourse. However, there are a number of limitations to this research, including lack of a consistent definition of CSA, failure to investigate gender as a moderator, and possible confounding of the CSA experience with some of the sexual behavior outcome variables. Further, although there appears to be an association between CSA and later sexual risk behavior, researchers have not established whether this association is causal. Suggestions for future research and implications for clinical practice are discussed.
Childhood sexual abuse (CSA) has been associated with HIV/AIDS risk behavior; however, much of this work is retrospective and focuses on women. The current study used semiparametric mixture modeling with youth (n = 844; 48.8% boys) from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) to examine the link between trajectories of CSA (2 to 12 y.o.) and HIV/AIDS risk behavior at age 14 (i.e., sexual intercourse & alcohol use). Trajectory analyses revealed a link between a history of CSA and the development of risky behavior. In addition, trajectories for physical and emotional abuse, but not neglect or witnessed violence, contributed to risky behavior over and above the role of CSA. Child gender did not moderate the findings. Findings highlight the signficance of CSA histories, as well as the broader context of maltreatment, for better understanding the development of risk behaviors in both girls and boys.
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.
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 posttraumatic stress disorder (PTSD) and depression symptoms.
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% versus 35%, p = .006). Different explanations about self-definition were provided by subgroups.
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.
Sexual abuse; Posttraumatic stress disorder; Depression; HIV risk behavior; Men
We examined potential differences in women’s likelihood of sexual risk taking in a laboratory setting based on alcohol intoxication and sexual abuse history. Participants (n = 64) were classified as sexually non-abused (NSA) or as having experienced sexual abuse in childhood only (CSA) or adulthood only (ASA) and randomly assigned to consume alcoholic (.06%, .08%, or .10% target blood alcohol content) or non-alcoholic drinks, after which participants read and responded to a risky sex vignette. Dependent measures included vaginal pulse amplitude, likelihood of engaging in condom use and risky sexual behaviors described in the vignette, self-reported sexual arousal, and mood. NSA and ASA women did not differ on any dependent measures. CSA women reported lower likelihoods of condom use and unprotected intercourse relative to NSA and ASA women. Intoxicated women reported greater sexual arousal, positive mood, and likelihood of risky sex relative to sober women. Intoxicated CSA women reported more likelihood of unprotected oral sex and less likelihood of condom use relative to intoxicated NSA and ASA and sober CSA women. CSA women’s increased risk of sexually transmitted infections (STIs) may be driven by non-condom use and behavioral changes while intoxicated. These findings provide preliminary insight into situational influences affecting CSA women’s increased STI risk.
sexual abuse; sexual arousal; acute alcohol intoxication; sexual risk; HIV/AIDS; STI; condom use; vaginal pulse amplitude; women
This study investigated the mechanisms of risk for urban women at high risk for HIV with and without childhood sexual abuse (CSA) histories. CSA survivors reported more unprotected intercourse and sexually transmitted infections (STIs). The association of STI locus of control with frequency of unprotected sex was fully mediated by being intoxicated during sex and engaging in sex work, whereas the association between relational control and unprotected sex was not mediated by contextual factors for the CSA group. The mechanisms of risk are different for those with divergent CSA histories and thus interventions should be developed to educate women with a history of CSA about ways to avoid revictimization, particularly within a context of poverty, prostitution, and drug use.
Childhood Sexual Abuse; Drug Use; Sexual Risk; HIV Risk; STI Risk
In Western countries, a history of major depression (MD) is associated with reports of received parenting that is low in warmth and caring and high in control and authoritarianism. Does a similar pattern exist in women in China?
Received parenting was assessed by a shortened version of the Parental Bonding Instrument (PBI) in two groups of Han Chinese women: 1970 clinically ascertained cases with recurrent MD and 2597 matched controls. MD was assessed at personal interview.
Factor analysis of the PBI revealed three factors for both mothers and fathers: warmth, protectiveness, and authoritarianism. Lower warmth and protectiveness and higher authoritarianism from both mother and father were significantly associated with risk for recurrent MD. Parental warmth was positively correlated with parental protectiveness and negatively correlated with parental authoritarianism. When examined together, paternal warmth was more strongly associated with lowered risk for MD than maternal warmth. Furthermore, paternal protectiveness was negatively and maternal protectiveness positively associated with risk for MD.
Although the structure of received parenting is very similar in China and Western countries, the association with MD is not. High parental protectiveness is generally pathogenic in Western countries but protective in China, especially when received from the father. Our results suggest that cultural factors impact on patterns of parenting and their association with MD.
Major depression; parent–child relations; psychometrics; risk factors; social behaviour
Many women with a history of childhood sexual abuse (CSA) experience difficulties becoming sexually aroused. This study measured cortisol and physiological sexual arousal during exposure to sexual stimuli in women with and without a history of CSA. CSA survivors showed a smaller decrease in cortisol during sexual arousal than the non-sexually abused, control group potentially due to an increase in cortisol in some of the participants in the CSA group. Physiological sexual arousal was weaker in CSA survivors compared to women with no history of sexual abuse and posttraumatic stress disorder symptoms showed characteristics consistent with mediation for the relationship between a history of CSA and inhibited sexual arousal responses.
Childhood sexual abuse (CSA) is associated with a wide range of negative outcomes. This study investigated the relation between CSA and sexual risk behavior in 827 patients recruited from an STD clinic. Overall, CSA was reported by 53% of women and 49% of men, and was associated with greater sexual risk behavior, including more sexual partners, unprotected sex, and sex trading. Alcohol use for men, and drug use for women, mediated the relation between CSA and the number of partners in the past three months; intimate partner violence mediated the relation between CSA and the number of episodes of unprotected sex in the past three months for women. These results document the prevalence of CSA among patients seeking care for an STD, and can be used to tailor sexual risk-reduction programs for individuals who were sexually abused.
child sexual abuse; sexually transmitted disease; HIV; alcohol use; drug use
Earlier studies have found an elevated risk for psychopathology and suicidal behavior associated with childhood sexual abuse (CSA); however the degree to which risk is mediated by depression and post-traumatic stress disorder (PTSD) in women and men remains unclear. We examined these issues in data from a family study of childhood maltreatment (N=2559). We found significant CSA-associated risk for depression, PTSD, and suicidal behavior for women and men. In survival analyses controlling for these disorders, we observed persistent, but somewhat reduced, CSA-associated risk for suicidal ideation and suicide attempt. Our findings thus suggest these disorders partially mediate CSA-associated risk.
Childhood sexual abuse (CSA) is associated with increased sexual risk behavior in adulthood, and this association may be mediated by traumagenic dynamics constructs (i.e., traumatic sexualization, trust, guilt, and powerlessness). However, few studies have investigated whether such relationships hold for women who do not identify as having experienced CSA despite meeting objective criteria that CSA occurred. This study sought to determine whether individuals who met research criteria for CSA and who self-defined as sexually abused differed on traumagenic dynamics constructs and current sexual risk behavior from individuals who met research criteria for CSA and who did not self-define as sexually abused.
Participants were 481 women recruited from a publicly-funded STD clinic. Participants completed a computerized survey assessing childhood sexual experiences and adult sexual risk behavior.
Of the total sample, 206 (43%) met research criteria for CSA. Of the women meeting research criteria for CSA, 142 (69%) self-defined as sexually abused. Women who met research criteria for CSA reported more traumatic sexualization, more trust of a partner, more powerlessness, less sexual guilt, more episodes of unprotected sex, more sex partners, and greater likelihood of sex trading, compared to women who did not meet research criteria for CSA. Among women meeting research criteria, those who self-defined as sexually abused did not differ from those who did not self-define on any of the traumagenic dynamics constructs or on current sexual risk behavior, controlling for CSA characteristics.
Individuals who were sexually abused as children by behavioral research criteria are at risk for engaging in sexual risk behavior as adults, regardless of whether or not they perceive the experience to be CSA. Future research is needed to understand how non-definers perceive these childhood sexual experiences.
This study assessed the prevalence of childhood sexual abuse (CSA) and its association with psychosocial outcomes among children in high HIV-prevalence communities in rural China. Data were collected from HIV orphans (n = 417; children who had lost one or both parents to HIV), vulnerable children (n = 326; children living with HIV-infected parents), and comparison children (n = 276; children who had not experienced HIV-related familial illness or death). About 30% reported having experienced at least 1 form of CSA; more boys (37%) than girls (24%) reported CSA; 24% reported only non-physical CSA, 5% reported both physical and non-physical CSA; 2% reported only physical CSA. Multivariate analysis revealed that CSA was significantly associated with problem behaviors and quality of life independent of key demographic factors. Findings suggest that these children were vulnerable to CSA and highlight the need to address the issues of CSA in this population.
children; childhood sexual abuse; China; HIV; psychosocial outcomes
Childhood sexual abuse (CSA) and physical abuse (CPA) are well-established risk-factors for a wide of range of proximal and distal outcomes. The lack of availability of an optimal design for examining abuse and its consequences has resulted in the use of various approaches, each having its own limitations. We describe the Childhood Trauma Study which ascertained families from a large young adult Australian twin cohort on the basis of twins’ responses to screening questions assessing CSA and CPA. We report data from 3407 participants including twins, non-twin siblings, and their parents. Our data demonstrate the feasibility of using a comprehensive assessment to evaluate retrospective history of childhood abuse in an adult sample. We observed that risk for each form of abuse increased incrementally with the number of parents with alcohol problems. Psychometric properties of our measures of CSA and CPA including reasonable long-term stability, construct validity, and evidence of familial corroboration compare favorably with those of other reports in which samples were considerably younger and assessments were repeated over shorter intervals.
childhood sexual abuse; parental alcoholism; physical abuse; reliability; retrospective recall
Childhood sexual abuse (CSA) is a problem of considerable proportion in Africa where up to one-third of adolescent girls report their first sexual experience as being forced. The impact of child hood sexual abuse resonates in all areas of health. The aim of this study was to describe the prevalence of childhood sexual abuse and variations across socioeconomic status in six sub-Saharan countries.
Datasets from Demographic and Health Surveys (DHS) in six sub-Saharan African countries conducted between 2003 and 2007 were used to access the relationship between CSA and socio economic status using multiple logistic regression models.
There was no association between CSA and education, wealth and area of settlement. However, there was contrasting association between CSA and working status of women.
This study concurs with other western studies which indicate that CSA transcends across all socio economic group. It is therefore important that effective preventive strategies are developed and implemented that will cross across all socio-economic groups.
Childhood Sexual abuse; sexual violence; sub-Saharan Africa; socio-demographic factors; demographic and health survey
This study reports the prevalence of child (CSA) and adult (ASA) sexual abuse among 535 African American HIV serodiscordant couples from four major United State cities, and its relationship to personal and couple related vulnerabilities and HIV risk factors. As part of a randomized, clinical trial, CSA and ASA histories were obtained through face-to-face interviews. Results indicate that HIV positive women were significantly more likely to report one kind of abuse (32.32%), either before or since age 18 or both (32.6%). HIV-positive men (34.9%) were significantly more likely to report CSA than HIV-negative men (22.0%). Overall, 72% of couples reported that one or both had CSA histories. These findings underscore the heightened emotional vulnerability, and STI and HIV transmission risk taking practices, associated with sexual abuse. Sexual abuse histories among couples should be assessed to better understand how these histories may contribute to couples dynamics and risk-taking practices.
HIV; Child sexual abuse; Adult sexual abuse; Serodiscordant; Sexual re-victimization; African-American couples
Insomnia frequently occurs with trauma exposure and depression, but can ameliorate with improvements in depression. Insomnia was assessed by the insomnia subscale of the Hamilton Rating Scale for Depression in 106 women with childhood sexual abuse (CSA) and major depression receiving Interpersonal Psychotherapy in an uncontrolled pilot (n = 36) and an immediately subsequent randomized controlled trial (n = 70) comparing IPT to treatment as usual. Depression improved in each study and in both treatment conditions; insomnia had smaller, non-significant improvements. Overall, 95 women (90%) endorsed insomnia on the Structured Clinical Interview for DSM-IV at baseline and, of those, 90% endorsed insomnia following treatment. Despite improvements in depression, insomnia persists for most women with CSA.
Childhood sexual abuse (CSA) has been associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in non-pregnant samples. However, it is not yet known whether CSA is associated with HPA dysregulation over pregnancy. In the present study we assessed whether maternal cortisol levels across pregnancy differed in women with CSA histories compared to women with histories of non-sexual child abuse (CA) and no abuse (NA).
135 pregnant mothers (CSA=30, CA=58, NA=47) provided salivary cortisol samples at wakeup, wake +30 minutes, and bedtime for 3 consecutive days at 1–3 time points over second and third trimester. Cortisol awakening responses and slopes were computed.
Women with CSA histories displayed increasing cortisol awakening response over pregnancy compared to women with CA and NA histories. Group differences were not observed for slope.
This is the first study to show that cortisol awakening responses increase over pregnancy in women with CSA histories compared to women with CA and NA histories.
child abuse; cortisol; cortisol awakening response; cortisol slope; pregnancy
Adult posttraumatic stress symptoms (PSS) and a biomarker index of current health risk in childhood sexual abuse (CSA) survivors was investigated in relation to CSA severity, disclosure and other peri-and post-trauma factors.
A community sample of 94 African American and Latina women CSA survivors was assessed.
Severe CSA predicted PSS overall, avoidance/numbing symptoms and greater biomarker risk, and was not mediated by post-trauma variables. Moderate CSA severity was mediated by post-trauma disclosure, predicted re-experiencing symptoms but was unrelated to biomarker risk. No overall ethnic differences were found.
Results suggest targets for interventions to improve the well-being of minority women CSA survivors.
Substance use and a history of childhood sexual abuse have both been identified as risk factors for unprotected sex among women, yet questions remain as to how their combined influence may differentially affect sexual risk behavior. In the current study a Generalized Linear Mixed Model was used to examine the interaction effect between current cocaine and opioid use and a history of childhood sexual abuse (CSA) on number of unprotected sexual occasions (USO) in a sample of 214 sexually active women in outpatient methadone maintenance treatment programs. Results show significant interaction effects between drug use in the past 30 days and CSA on unprotected sexual occasions. These interactions, however, differ depending on type of drug used and CSA status. For women with CSA, an increase in days of cocaine use was significantly associated with an increase in USO, whereas an increase in number of days of opiate use was not significantly associated with an increase in USO. In contrast, for women who did not report CSA, an increase in number of days of cocaine use was associated with a significant decrease in USO and number of days of opiate use was significantly correlated with an increase in USO. Findings indicate that CSA is related to unprotected sexual occasions depending on drug type and severity of use. Women with childhood sexual abuse using cocaine are at particularly high risk for having unprotected sex, which suggests that this group of women should be specifically targeted for HIV prevention interventions.
The literature shows a discrepancy in the association between child sexual abuse (CSA) and adult sexual function. One of the proposed explanations for this discrepancy is the different ways in which CSA is assessed. While some studies explicitly ask potential participants whether they are sexual abuse survivors, others ask whether participants experienced specific unwanted sexual behaviors.
This study investigated the differences between women who self-identified as CSA survivors, women who experienced similar unwanted sexual experiences but did not identify as CSA survivors (NSA), and women with no history of sexual abuse (control). CSA was defined as unwanted touching or penetration of the genitals before the age of 16.
A sample of 699 college students anonymously completed a battery of questionnaires on sexuality and sexual abuse history.
Main Outcome Measures
Sexual function was measured with the Female Sexual Function Index (FSFI), and sexual satisfaction was measured with the Sexual Satisfaction Scale-Women. History of CSA was measured with a modified version of Carlin and Ward’s childhood abuse items.
Differences emerged between women who experienced sexual abuse before age 16 and women who never experienced sexual abuse (control) on the personal distress subscale of the Sexual Satisfaction Scale. The CSA group (N = 89) reported greater sexual distress compared to the NSA (N = 98) group, and the NSA group reported more distress than the control group (N = 512). No significant group differences were observed in the FSFI. Characteristics of the abuse that predicted whether women identified as CSA survivors included vaginal penetration, fear at the time of the abuse, familial relationship with the perpetrator, and chronic frequency of the abuse. These abuse characteristics were associated with sexual satisfaction but not with sexual function.
Differences in levels of sexual satisfaction between women with and without a history of CSA were associated with the type of CSA definition adopted. It remains unexplained why the CSA group showed more personal distress about their sexuality but not more sexual dysfunction.
Child Sexual Abuse; Sexual Arousal; Sexual Function; Sexual Satisfaction; Sexual
Among adult women an association between childhood sexual abuse (CSA) and obesity has been observed. Research with lesbian women has consistently identified high rates of obesity as well as frequent reports of CSA, but associations between sexual abuse and obesity have not been fully explored. Our aim was to investigate the relationship between sexual abuse (SA) history and obesity among heterosexual (n = 392) and lesbian (n = 475) women (age 35–64) who participated in the Epidemiologic STudy of HEalth Risk in Women (ESTHER) Project in Pittsburgh, Pennsylvania.
Obesity was defined as body mass index (BMI) ≥30. Covariates included self-reported SA, sexual orientation, demographic factors, and history of a depression or anxiety diagnosis. SA history was assessed by three factors: (1) SA experienced under the age of 18 by a family member or (2) by a nonfamily member and (3) forced, unwanted sexual experience(s) at age ≥18. Data were analyzed using chi-square tests and logistic regression models.
Multiple logistic regression analyses revealed that obesity was associated with African American race, lesbian sexual orientation, intrafamilial CSA, and history of mental health diagnosis. Protective factors were having a household income of at least $75,000 and having a bachelor's degree or higher.
Results suggest that lesbian women may be at greater risk of obesity than heterosexual women and that intrafamilial CSA—regardless of sexual orientation—may play a role in the development of obesity.
The current study examined the manner in which childhood sexual abuse (CSA) history relates to risk factors for suicidal behavior among recent suicide attempters (n = 166). Men who recently attempted suicide and endorsed a CSA history had higher scores on measures of hopelessness and suicide ideation than men without a CSA history. Men with a CSA history were also more likely to have made multiple suicide attempts and meet diagnostic criteria for posttraumatic stress disorder and borderline personality disorder. In contrast, there were fewer group differences as a function of CSA history among the female suicide attempters. Hopelessness was a significant mediator between CSA history and suicide ideation in both men and women.
We examine interactive effects of childhood sexual abuse (CSA) on heritable variation in age at first consensual sexual intercourse in a young cohort of 3,350 female and 2,724 male Australian twins. Consistent with hypotheses, genetic influences explained little if any variation in age at first consensual sexual intercourse for female twins reporting CSA (CSA+), with shared environment explaining 73%. For female twins reporting no history of CSA (CSA−), 39% of variation in age at first consensual sexual intercourse was explained by genetic effects, with shared environment accounting for 30%. For male twins, significant interactive effects of CSA on genetic and environmental variation in age at first consensual sexual intercourse were not observed. Overall genetic influences explained 51% of variation in age at first consensual sexual intercourse for male twins, with shared environment accounting for 8%. For both female and male twins, results from models that included conduct disorder as a covariate were near identical to results from models without conduct disorder.
Age at first consensual sexual intercourse; Childhood sexual abuse (CSA); Behavior genetics; Gene–environment interaction