Suicidal behavior and associated factors in sexually abused adolescents

Objectives

The aim of the present study is to determine the rate of suicidal ideation and suicide attempts in sexually abused adolescents and to determine the factors associated with suicidal behavior.

Method

106 adolescents between the ages of 12–18 (94 girls, 12 boys) who were exposed to sexual abuse and referred for the preparation of forensic reports were included in the study. The investigators retrospectively examined the case files, forensic reports and social worker reports.

Results

It has been found that in cases exposed to sexual abuse, suicidal ideation developed in 63.2% (n = 67) of the individuals and 24.5% (n = 26) of them attempted suicide. The rate of suicidal ideation and suicide attempts was higher in cases who live separately from one or both parents, those who have ASD or PTSD after sexual abuse, cases in which abuse involved penetration, cases who were abused by someone known or someone from the family, cases where sexual abuse was accompanied by coercion and physical violence, and those who were exposed to abuse continuously. Among girls, in cases who have suicide history before sexual abuse and those who were abused by more than one abuser, the rate of suicidal ideation was higher.

Conclusion

It has been shown in many studies that sexual abuse in childhood increases the risk of suicidal behavior. Consideration of the factors associated with suicidal behavior in victims of sexual abuse will be helpful to clinicians in preventing suicide attempts.     

The effects of familial acculturative stress and hopelessness on suicidal ideation by immigration status among college students

Objectives: Based on acculturative family distancing theory, we examined whether familial acculturative stress interacted with hopelessness to predict suicidal ideation differentially among emerging adult immigrant versus nonimmigrant college students. Participants: We recruited 152 generationally and racially/ethnically diverse college students (42 immigrants) from 2012 to 2013. Methods: Participants completed measures of hopelessness, depressive symptoms, ethnic identity, familial acculturative stress, and suicidal ideation. Results: Immigrant status interacted with hopelessness and familial acculturative stress. Hopelessness was associated with less suicidal ideation among immigrants than among nonimmigrants at a familial acculturative stress score below the 11th percentile, but greater suicidal ideation among immigrants than among nonimmigrants at a familial acculturative stress score above the 72nd percentile. Conclusions: Familial acculturative stress may exacerbate the effect of hopelessness on suicidal ideation among immigrant college students, and should be monitored during suicide risk assessment and treatment.     

Gender Differences in Sexually Abused Children and Adolescents: A Multicenter Study in Turkey

The purpose of this study was to examine gender-based differences in abuse-related characteristics and post-abuse psychiatric disorders among sexually abused children and adolescents. The researchers retrospectively examined files, judicial reports, and social examination reports of 1,250 sexually abused youth cases. Results showed that boys were more often victimized by penetration, force, and physical violence. Incidence of sexual abuse by family members, familiar persons, and multiple persons was higher among girls. In addition, a higher rate of major depressive disorder as well as alcohol consumption and cigarette smoking were found in sexually abused girls. No difference was observed between boys and girls in terms of post-traumatic stress disorder, conduct disorder, and other mental disorders. Intellectual disability was more frequent in boys.     

Perceived Loss of Social Contact and Trauma Symptoms among Adolescents Who Have Experienced Sexual Abuse

ABSTRACT

Child sexual abuse (CSA) is a robust predictor of trauma symptoms. Past research has identified many correlates of trauma symptoms following disclosure of CSA. Theory suggests that loss of social contact may be another important contributor to adolescents’ trauma symptoms following CSA. A clinical sample of 166 adolescents (95% female) between 11 and 19 years (M = 13.80, SD = 1.87) reported on perceived loss of social contact, the extent to which the CSA was coercive, appraisals of self-blame for the abuse, supportiveness of a primary non-abusing caregiver, and trauma symptoms. The adolescent’s relationship to the abuser, abuse severity and duration were coded from forensic interviews. Results indicated that greater perceived loss of social contact was associated with higher levels of trauma symptoms, even after controlling for other correlates of trauma symptoms and demographic variables. These findings suggest that perceived loss of social contact may be an important variable to consider in assessing and intervening with adolescents who have been sexually abused.     

Predictors of suicidal ideation among college students: A prospective cohort study

ABSTRACT

This prospective cohort study investigated longitudinal predictors of suicidal ideation among college students. A non-clinical cohort of college students (N = 171) completed baseline and 3-month follow-up surveys. Depressive symptoms, worst-point suicidal ideation, and suicide attempt history significantly predicted follow-up suicidal ideation severity after adjusting covariates. Similarly, depressive symptoms and worst-point suicidal ideation (but not attempt history) were significant predictors of follow-up suicidal ideation intensity in an adjusted model. The results suggest that current depressive symptoms and lifetime worst-point suicidal ideation are independently valuable constructs that may provide relatively short-term predictive information when screening for suicidal ideation among college students.     

Self-destructive and delinquent behaviors of adolescent female victims of child sexual abuse: rates and covariates in clinical and nonclinical samples

Self-destructive and delinquent behaviors were assessed in three samples of adolescent females. The first sample (N=140) were substantiated victims of sexual abuse recruited from clinical settings. They were contrasted to a second sample (N=430) of secondary school students, and a third sample from the same school setting (N=94), that reported that they had been sexually abused. Few differences were found between the two groups of sexually abused girls, and both groups reported significantly more at-risk behaviors than nonabused girls. Family adversity was a consistent predictor of both self-destructive and delinquent behaviors. However, violence during the abuse, lower quality mother-daughter relationships, and depression were also related to self-destructive behaviors, while family economic problems and self-blame for the abuse were the only correlates of delinquent behavior.     

Identification of Sexually Abused Female Adolescents at Risk for Suicidal Ideations: A Classification and Regression Tree Analysis

This study explored the clinical profiles of 77 female teenager survivors of sexual abuse and examined the association of abuse-related and personal variables with suicidal ideations. Analyses revealed that 64% of participants experienced suicidal ideations. Findings from classification and regression tree analysis indicated that depression, posttraumatic stress symptoms, and hopelessness discriminated profiles of suicidal and nonsuicidal survivors. The elevated prevalence of suicidal ideations among adolescent survivors of sexual abuse underscores the importance of investigating the presence of suicidal ideations in sexual abuse survivors. However, suicidal ideation is not the sole variable that needs to be investigated; depression, hopelessness and posttraumatic stress symptoms are also related to suicidal ideations in survivors and could therefore guide interventions.     

Coping,Emotion Regulation,and Self-Blame as Mediators of Sexual Abuse and Psychological Symptoms in Adult Sexual Assault

This study examined whether coping, emotion regulation, and self-blame mediate relationships of trauma histories with post-traumatic stress disorder and depression in adult sexual assault victims (N = 1863). A path analysis showed that theorized mediators partially mediated associations between trauma history variables and psychological symptoms. Specifically, child sexual abuse severity was related to greater post-traumatic stress disorder and depression indirectly through maladaptive coping and decreased emotion regulation but not self-blame. Other traumas had direct relationships with symptoms and partially mediated effects through maladaptive coping and emotion regulation. Child sexual abuse was unrelated to self-blame, but other traumas were related to greater self-blame. Results differed according to whether women had counseling post-assault. Implications are drawn for future research and clinical treatment of adult sexual assault victims.     

Correlates of Sexual Abuse in a Sample of Adolescent Girls Admitted to Psychiatric Inpatient Care

We examined correlations of child sexual abuse among 300 adolescent girls in psychiatric inpatient treatment. Diagnostic and Statistical Manual of Mental Disorders (4th ed.)-based psychiatric diagnoses were obtained from the Schedule for Affective Disorder and Schizophrenia for School-Age Children—Present and Lifetime and from data on family and behavioral characteristics from the European Addiction Severity Index (EuropASI). A total of 79 girls (26.3%) had experienced child sexual abuse during their lifetime. Child sexual abuse was associated with an adolescent’s home environment, sibling status, smoking, posttraumatic stress disorder diagnosis, self-mutilating behavior, and suicidal behavior. At least 62% of the perpetrators were acquaintances of the victims. Correlates of child sexual abuse can be used to identify child sexual abuse victims and persons at heightened risk for child sexual abuse.     

Suicidal Thoughts/Behaviors in Sexually Abused Children

This study examined the frequency of suicidality based on self-report and parent report in 430 sexually abused outpatient youth ages 3 to 17. Thirty-four percent of youth experienced suicidal ideation or behavior. However, when both parent and child completed measures, the rate of suicidality increased to 45.3%. The prevalence of suicidal thoughts and behavior was not higher based on relationship to the perpetrator, race, or previous placement outside the home. Suicidal youth rated themselves as more depressed, anxious, and angry on self-reports. Child self-reports of post-traumatic stress disorder were greater among the suicidal youth. Parent reports of depression and post-traumatic stress disorder were greater among suicidal youth. A logistic regression model including Trauma Symptom Checklist for Children Depression and Anger scores correctly classified 74.2% of suicidal and nonsuicidal children and adolescents, but not self-criticism, was predicted by depression and anger. These findings support the need for formal multi-informant evaluations of suicidality in sexually abused youth.     

The Indirect Effect of Child Maltreatment Severity on Adult PTSD Symptoms through Anxiety Sensitivity

Although the rate of posttraumatic stress disorder (PTSD) among survivors of child maltreatment is high, individuals differ in symptom severity and many do not experience clinically significant levels of psychopathology. The present study tested the indirect effects of child maltreatment severity on adult PTSD, suicidal ideations, and alcohol dependence via anxiety sensitivity. A sample of 336 participants (mean age of 22.81 years, SD = 8.93; 70.2% female) completed an online survey of child abuse and neglect, anxiety sensitivity, PTSD symptom severity, suicidal ideation severity, and alcohol dependence severity. The results revealed significant indirect effects of child maltreatment on PTSD symptom severity through cognitive and social concerns, but not physical concerns. No direct or indirect effects were demonstrated for suicidal ideations or alcohol dependence severity. These findings elucidate mechanisms in the robust relationship between child maltreatment and adult PTSD symptoms and can potentially inform future research on mechanisms of change in psychotherapy.     

Psychophysiological Reactivity in Child Sexual Abuse

Sexual abuse has physiological and emotional implications. The purpose of this study is to evaluate the neurobiological sequels of childhood sexual trauma by monitoring physiological variables among sexually abused girls and women compared to controls. We assessed posttrauma and traumatic life events of 35 females sexually abused in their childhood (age range 7–51 years) and 25 control females (age range 7–54 years). Electroencephalography, frontalis electromyography, electrodermal activity, and heart rate parameters were recorded while watching sets of pictures representing neutral and trauma-suggestive stimuli. A minority of participants met the Diagnostic and Statistical Manual of Mental Disorders criteria for post-traumatic stress disorder. Abused females displayed significant elevations in heart rate, electromyography, and electroencephalography while viewing allusive stimuli and elevated heart rate while viewing neutral stimuli. The dysfunctional regulation of the physiological stress system associated with child sexual abuse may endanger the victims with various stress and anxiety disorders.     

The Clinical Correlates of Reported Childhood Sexual Abuse: An Association Between Age at Trauma Onset and Severity of Depression and PTSD in Adults

This study investigated the relationship between the age of -self‐reported sexual abuse occurrence and the development of post-traumatic stress disorder and/or depressive symptoms in adulthood. Subjects were evaluated for the presence of post-traumatic stress disorder and/or depressive symptoms as well as for a self-reported history of sexual abuse before the age of 18. Results found that relative risk of having severe post-traumatic stress disorder symptoms was 10 times higher in patients reporting sexual abuse after age 12 than in those reporting sexual abuse before age 12. Relative risk of having severe depressive symptoms was higher for those abused before the age of 12 than for those abused after the age of 12. Findings suggest that the impact of reported sexual abuse at different stages of development may lead to distinct psychiatric symptoms in adulthood.     

Peritraumatic Tonic Immobility and Trauma-Related Symptoms in Adult Survivors of Childhood Sexual Abuse: The Role of Posttrauma Cognitions

Tonic immobility is a set of involuntary motor responses elicited under conditions of extreme fear and perceived inescapability, and it is one type of peritraumatic distress reported by survivors of child sexual abuse. Experiencing tonic immobility during child sexual abuse is associated with increased risk for developing symptoms of post-traumatic stress disorder, although less is known about relations between tonic immobility and other established risk factors for post-traumatic stress disorder. We investigated posttraumatic cognitions as a potential mediator of the relations between peritraumatic fear, perceptions of inescapability, tonic immobility, and post-traumatic stress disorder symptoms. Specifically, we tested posttraumatic negative beliefs about the self, the world, and self-blame as pathways that might increase risk for post-traumatic stress disorder symptoms in child sexual abuse survivors who had experienced tonic immobility. Forty-six women with a history of unwanted childhood sexual contact completed questionnaires measuring peritraumatic tonic immobility, posttraumatic cognitions, and current posttraumatic stress symptoms. Negative beliefs about the self independently mediated the relation between peritraumatic perceptions of inescapability and post-traumatic stress disorder symptoms, but the data did not support similar path model for the physical symptoms of tonic immobility and post-traumatic stress disorder. We discuss ways in which treatment of survivors and future research on CSA can benefit from attention to the impact of peritraumatic distress on posttraumatic beliefs.     

Sexual Debut and Mental Health Among South Korean Adolescents

Numerous studies have demonstrated the negative influence of sexual debut during adolescence on mental health outcomes. This article contributes to this literature by investigating whether sexual debut has negative effects on mental health among South Korean adolescents and whether the timing of adolescent sexual debut matters. Drawing on longitudinal data from a nationally representative survey, we first predicted mental health outcomes at one year after high school graduation using first sexual intercourse that had occurred before the outcomes were measured. In a second statistical model, adolescent sexual debut was defined as first coitus that had occurred before high school graduation. Sexual debut was associated with an increase in problematic aggressive behaviors for both genders. In contrast, only girls experienced a rise in depressive symptoms after becoming sexually active. For girls, having sex before high school graduation was correlated with worse mental health outcomes to the extent that sexual debut even enhanced the risk of suicidal ideation. We concluded that the negative effects of sexual activity among South Korean adolescents are attributable mainly to the sexually conservative atmosphere and gendered sexuality in that country.     

Contributions of Child Sexual Abuse,Self-Blame,Posttraumatic Stress Symptoms,and Alcohol Use to Women’s Risk for Forcible and Substance-Facilitated Sexual Assault

Child sexual abuse and adult sexual assault have been linked to increased self-blame, posttraumatic stress symptoms, and alcohol use. The current study aims to examine (a) whether these constructs explain women’s risk for later adult sexual assault and revictimization, (b) whether such factors differentially confer risk for specific types of adult sexual assault (i.e., substance-facilitated and forcible), and (c) if self-blame confers risk indirectly through other risk factors. Multiple types of self-blame, posttraumatic stress, and alcohol use were examined among 929 female college students as serial mediators of the relationship between child sexual abuse and adult sexual assault and as risk factors for sexual revictimization among child sexual abuse survivors. In the model predicting risk for substance-facilitated adult sexual assault, child sexual abuse indirectly predicted greater risk for substance-facilitated adult sexual assault mediated through two separate paths: global blame-to-posttraumatic-stress and global blame-to-alcohol use. In the model predicting risk for forcible adult sexual assault, child sexual abuse directly predicted greater risk for forcible adult sexual assault, and this relation was mediated by the global blame-to-posttraumatic-stress path. Among child sexual abuse survivors, child sexual abuse specific characterological and behavioral self-blame directly predicted greater risk for forcible and substance-facilitated revictimization, but the pathways were not mediated by posttraumatic stress or alcohol use. Results emphasize the importance of assessing different types of self-blame in predicting posttraumatic stress symptoms as well as examining risk for sexual victimization and revictimization. Findings did not support hypotheses that increased posttraumatic stress would predict increased alcohol use but did indicate that heightened self-blame is consistently associated with heightened posttraumatic stress and that heightened global self-blame predicts increased alcohol use. Implications for future research and intervention are discussed.     

Gender Differences in the Characteristics and Outcomes of Sexually Abused Preschoolers

ABSTRACT

This study examined whether sexually abused preschool boys and girls (ages 2–5) differed in terms of abuse characteristics or psychological outcomes. A retrospective chart review of 74 cases of sexually abused children (29 boys and 45 girls) treated at an urban mental health clinic in Maryland was conducted. Information was collected on: (1) demographics; (2) abuse characteristics (victim's age, type of sexual abuse, relationship to perpetrator); (3) abuse discovery pattern (accidental vs. purposeful); (4) children's symptomatology; and (5) child and familial factors. No differences were found between boys and girls in terms of the victim's age at the time of abuse, perpetrator's age, or the identity of the perpetrator. However, boys and girls experienced different forms of abuse; boys were more likely to experience fondling, oral and anal intercourse. The majority of boys and girls were abused by males, typically someone they knew (biological parent/parent figure or relative). No differences were evident in the type of disclosure; however, older children were more likely to self-disclose than younger children. Results indicated that boys exhibited more developmental delays and aggressive symptoms than girls. Clinical implications of these findings are discussed as well as recommendations for future research.     

Indicators of Adolescent Depression and Relationship Progression in Emerging Adulthood

Adolescent depression may be associated with future relationship problems that have long‐term consequences given the developmental importance and health benefits of forming committed unions in emerging adulthood. The authors examined associations between emotional and behavioral indicators of adolescent depression (depressive symptoms, alcohol problems, and suicidal ideation) and romantic relationship and union formation and dissolution in emerging adulthood (n = 14,146) using the National Longitudinal Study of Adolescent Health. Adolescent alcohol problems were associated with more romantic relationships in emerging adulthood. Emerging adults with depressive symptoms or alcohol problems in adolescence were significantly more likely to enter into a cohabiting union, and those with adolescent alcohol problems were less likely to marry. Cohabiting emerging adults with a history of adolescent depressive symptoms were less likely to marry, whereas suicidal ideation was associated with a decreased likelihood of cohabitation dissolution. Implications for future research are discussed.     

Sexual at-risk behaviors of sexually abused adolescent girls

The present study investigated sexual at-risk behaviors of sexually abused adolescent girls. Variables of interest were presence of consensual sexual activity, age at first consensual intercourse, number of sexual partners, condom use, and pregnancies. Participants were 125 sexually abused adolescent girls aged 12 to 17 years. Results showed that severity of sexual abuse (e.g., penetration, multiple perpetrators, physical coercion, multiple incidents of abuse) was related to a greater number of sexual at-risk behaviors. For instance, adolescents with a history of sexual abuse involving penetration were 13 times as likely to have been pregnant. Although family characteristics were significantly associated with being sexually active, their effect proved non-significant in the final hierarchical regression. Regression analyses clearly showed that the likelihood of engaging in sexual at-risk behaviors increased as a function of the number of severity factors.