The impact of childhood stressful life events on health and behavior in at-risk youth

Stressful life events experienced in childhood affect heath throughout the lifespan. Given the high prevalence of stressful life events, especially for children at-risk for child welfare involvement, the impacts of these events across different developmental stages need to be better understood. The current study examines the relation between previously experienced stressful life events and psychosocial health and risk behaviors in adolescence. Several links between maltreatment and psychosocial health were found. Namely, youth who had experienced sexual abuse were more likely to report anxious arousal symptoms, youth who had experienced physical maltreatment and emotional maltreatment were more likely to drop out of school, and youth who had experienced neglect were more likely to dropout, have unprotected sex and use cigarettes. Latent class analysis of life events revealed three groups of children with certain patterns of life events: Chronic, Moderate/Declining, and Low Life Events. After accounting for gender, race, and exposure to maltreatment, members of the Chronic Life Events group uniquely and significantly predicted higher likelihood of Anger/Irritability, Depression, Intrusive Experiences, and Dissociation on the Trauma Symptom Inventory at age 18. Additionally, members of the Chronic Life Events group were significantly more likely to drop out of school, have more sexual partners, be arrested more often and use marijuana or other illicit drugs more often. Membership in the Moderate/Declining Life Events group was significantly associated with likelihood of dropping out of school. The amount of stressful life events appears to be strong predictors of psychosocial outcomes and risk behaviors in adolescence. Efforts to intervene and prevent childhood exposure to stressful life events—particularly in children at-risk and/or maltreated—should begin early in life and continue throughout childhood and adolescence.     

Childhood Maltreatment,Bullying Victimization,and Psychological Distress Among Gay and Bisexual Men

Sexual minority men report higher psychological distress than heterosexual men, including depression and anxiety. Research suggests that these health disparities may be due to the heightened stressors that gay, lesbian, and bisexual individuals experience. Some of these stressors occur early on in life, such as childhood abuse and bullying, and may include stressors that are topically related to sexual minority status, such as anti-gay bullying and teasing for gender nonconformity to masculine gender norms. We tested a structural equation model on the association between negative childhood experiences and adult psychological distress among 304 gay and bisexual men. The model fit the data well, and demonstrated an indirect effect of negative childhood experiences on adult psychological distress via dysfunctional thoughts toward oneself. The results integrate the childhood abuse and anti-gay bullying victimization literatures by showing that both forms of adverse childhood experiences are associated with adult psychological distress. The findings suggest the benefit of treatments to reduce negative, dysfunctional thoughts among gay and bisexual men who have experienced adverse childhood events.     

Child maltreatment, revictimization, and violent behavior

The study investigates the cumulative impact of child maltreatment and victimization in adolescence on violent behavior in young adulthood in a nonclinical high-risk sample. The sample consists of 1,526 incarcerated young men (14 to 24 years) who were interviewed with standardized instruments during their prison term. Violent and nonviolent offenders with and without repeated victimization experiences throughout the life cycle were compared. Results show that child maltreatment doubles the risk for violent victimization in adolescence. Repeated victimization experiences in adolescence heighten the risk for later violent offending. This is the case for officially registered violence and self-reported violent behavior. In addition, child maltreatment increased the probability of self-reported violence as well. However, the interaction effect of victimization in childhood and victimization in early adolescence counteracted the main effects. Being repeatedly victimized throughout the early life cycle slightly reduced the probability of being a frequent offender.     

Risky Sexual Behaviors and Pregnancy Outcomes in Young Adulthood Following Substantiated Childhood Maltreatment: Findings From a Prospective Birth Cohort Study

Childhood maltreatment is associated with a range of adverse mental and physical health outcomes, including increased rates of sexually transmitted infections (STIs) later in life. However, the impact on risky sexual behaviors and pregnancy outcomes has not been adequately studied. This is particularly true for physical abuse, emotional abuse, and neglect. We examined associations between prospectively substantiated childhood maltreatment and reports of risky sexual behaviors by men and women, as well as selected pregnancy outcomes in women. We followed up 3,081 (45.7% female) participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian birth cohort study. Using logistic regression, we examined the association between substantiated childhood maltreatment from birth to 14 years, and self-reported risky sexual behaviors and youth pregnancy outcomes at the 21-year follow-up. In adjusted analyses, children who had experienced multiple childhood maltreatment exhibited more risky sexual behaviors than their nonmaltreated counterparts. In specific models, those exposed to each form of childhood maltreatment, independent of co-occurring forms of childhood maltreatment, had an increased likelihood of risky sexual behaviors, particularly an early sexual debut and, for women, youth pregnancy. Neglect was also associated with multiple sexual partners, and emotional abuse with higher rates of miscarriage. There was no difference between men and women in how different forms of childhood maltreatment predicted risky sexual behaviors in young adulthood. All forms of substantiated childhood maltreatment, including multiple substantiations, were associated with risky sexual behavior in both sexes as well as higher rates of youth pregnancy in women. Moreover, emotional abuse persistently predicted miscarriages in young adult women. Understanding the association between childhood maltreatment and risky sexual behaviors and youth pregnancy outcomes may help suggest preventive strategies.     

The Role of Youth Problem Behaviors in the Path From Child Abuse and Neglect to Prostitution: A Prospective Examination

Behaviors beginning in childhood or adolescence may mediate the relationship between childhood maltreatment and involvement in prostitution. This paper examines 5 potential mediators: early sexual initiation, running away, juvenile crime, school problems, and early drug use. Using a prospective cohort design, abused and neglected children (ages 0–11) with cases processed during 1967–1971 were matched with nonabused, nonneglected children and followed into young adulthood. Data are from in-person interviews at approximately age 29 and arrest records through 1994. Structural equation modeling tested path models. Results indicated that victims of child abuse and neglect were at increased risk for all problem behaviors except drug use. In the full model, only early sexual initiation remained significant as a mediator in the pathway from child abuse and neglect to prostitution. Findings were generally consistent for physical and sexual abuse and neglect. These findings suggest that interventions to reduce problem behaviors among maltreated children may also reduce their risk for prostitution later in life.     

Understanding Attachment Transitions Through the Lived Experiences of Young Black Gay and Bisexual Men

We conducted a mixed-methods study to identify factors that influence transitions in attachment style between childhood and adulthood among 28 young Black gay and bisexual men (YBGBM) in the United States. We used a phenomenological approach to data integration, with the major component to the results being garnered from the qualitative interviews. We organized our results by four attachment transition groups: stable secure (secure attachment in childhood and young adulthood), stable insecure (insecure attachment in childhood and young adulthood), secure to insecure (secure in childhood and insecure in adulthood) and insecure to secure (insecure in childhood and secure in adulthood). Within each of the typologies, two major themes emerged: social support and religion. Generally, transitions from secure to insecure attachment were related to experiences of perceived rejection by a parental figure during adolescence that corresponded with sexual orientation disclosure. Transitions from insecure to secure attachment appeared to be related to the absence of an attachment figure early in life, but with the acquisition of an attachment figure during early to late adolescence. The findings from our study suggest a need for attachment-based approaches to social support interventions, as well as for an increased understanding of social and cultural factors that impact attachment changes among practitioners who use attachment-based therapy models for YBGBM.     

Experiencing release: sex environments and escapism for HIV-positive men who have sex with men

There are nonsexual reasons that may motivate people to seek out sexual activity with others. Some men who have sex with men may seek out sex environments to engage in sexual behavior. Among the nonsexual reasons that exist for men who have sex with men is a desire to escape from distressing thoughts and feelings. The amplified sexuality and other unique characteristics of sex environments allow men to have more intense emotional experiences around sex. Using the cognitive escape model as a theoretical foundation, this analysis focuses on the emotional vulnerability that some of the men who visit these venues may be avoiding and how their experiences at these venues might act as releasing mechanisms to alleviate dissonant thoughts and feelings. Implications for public health services and future research are discussed.     

Early Childhood Maltreatment and Pubertal Development: Replication in a Population‐Based Sample

Early experiences are critically important for female reproductive development. Although a number of early childhood hardships predict earlier physical development in girls, research on specific populations suggests a distinct effect of childhood sexual abuse compared to other adversities. This study leverages the National Longitudinal Study of Adolescent Health (N = 6,273 girls) to test the generalizability of these findings, examining associations of early physical abuse, sexual abuse, and physical neglect with pubertal timing. Child sexual abuse predicted earlier menarche and development of secondary sexual characteristics, whereas other types of maltreatment did not. In addition to replicating results from smaller, more specialized samples, these findings reinforce the value of considering puberty within a broader “life span” continuum of birth to adolescence.     

Childhood Sexual Experiences and Adult Health Sequelae Among Gay and Bisexual Men: Defining Childhood Sexual Abuse

Gay and bisexual men carry the burden of HIV infections in the United States and have high rates of childhood sexual abuse that predict HIV and other health outcomes. This study examined differential effects of forced, consensual, and no childhood sexual experiences (CSE) on health outcomes among a probability sample of adult men who have sex with men (MSM). The forced sex group had the highest levels of psychological distress, substance use, and HIV risk. There were no differences in rates of depression and suicidal ideation between the consensual- and no-sex groups. The consensual- and forced-sex groups had higher rates of substance use and transmission risk than the no-sex group. The forced-sex group, however, had significantly higher rates of frequent drug use and high-risk sex than the consensual group. Findings suggest that forced CSEs result in a higher-risk profile than consensual or no childhood sexual experiences, the kind of risk pattern differs between forced and consensual childhood sexual experiences, and the underlying mechanisms that maintain risk patterns may vary. It is important to clarify risk patterns and mechanisms that maintain them differentially for forced and consensual sex groups so that interventions may be tailored to the specific trajectories related to each experience.     

Childhood sexual experiences and adult health sequelae among gay and bisexual men: defining childhood sexual abuse

Gay and bisexual men carry the burden of HIV infections in the United States and have high rates of childhood sexual abuse that predict HIV and other health outcomes. This study examined differential effects of forced, consensual, and no childhood sexual experiences (CSE) on health outcomes among a probability sample of adult men who have sex with men (MSM). The forced sex group had the highest levels of psychological distress, substance use, and HIV risk. There were no differences in rates of depression and suicidal ideation between the consensual- and no-sex groups. The consensual- and forced-sex groups had higher rates of substance use and transmission risk than the no-sex group. The forced-sex group, however, had significantly higher rates of frequent drug use and high-risk sex than the consensual group. Findings suggest that forced CSEs result in a higher-risk profile than consensual or no childhood sexual experiences, the kind of risk pattern differs between forced and consensual childhood sexual experiences, and the underlying mechanisms that maintain risk patterns may vary. It is important to clarify risk patterns and mechanisms that maintain them differentially for forced and consensual sex groups so that interventions may be tailored to the specific trajectories related to each experience.     

New Directions for Research Examining Sexual Trauma Histories of Gay Men

Summary

Research efforts have been unable to accurately examine the effect of childhood sexual trauma in the adult lives of gay men. Complications stemming from precise definitions of abuse, as well as the subjectivity inherent in the terms, make comprehensive research difficult. As abuse and traumatic events may sometimes be subtle and not involve overt violence, these more delicate events are often overlooked or unaccounted for. Further, because it is a complex endeavor to obtain accurate reporting from children, research efforts rely on the self-reports of adults remembering traumatic events. The symptomatology that results from trauma, including amnesia and dissociation, also affects the reliability of self-report. Additionally, gay men have been notably absent from sexual trauma research efforts for a variety of reasons. A research study which investigates childhood sexual trauma in the histories of adult gay men is discussed. Directions for future research efforts are suggested.     

Gender Differences in Silencing Following Childhood Sexual Abuse

ABSTRACT

The clinical literature commonly asserts that males are less likely than females to disclose child sexual abuse at the time it occurs and take longer to discuss their experiences. These hypotheses were tested in this study. This study included 145 men and 151 women. Participants were asked about disclosure at the time of the abuse and the length of time it took for them to discuss the experience. Comparison across these two studies found that boys were significantly less likely than girls to disclose the abuse at the time it occurred and also took significantly longer to discuss their childhood experiences later in life.     

Life Stress and Depression in University Students: Clinical Illustrations of Recent Research

Abstract

Through the use of case vignettes, this paper demonstrates the clinical relevance of findings from previously reported research conducted at the University of Toronto. These published studies link life stress to depression in university students. Three psychosocial factors—a family history of psychiatric illness, stressful life events, and lack of social support—are found to be significantly related to depressive symptoms. A fourth psychosocial factor, childhood or adolescent loss of a nurturing person, was not significantly related to the occurrence of depression. However, that factor remains an important therapeutic focus for a number of depressed students. In addition, the absence of at least a single confidant and certain life events (recent loss of a significant person, changes in living arrangements or academic situation, and financial problems) were identified as specific risk factors for depression. Although depression experienced by students is often serious enough to warrant professional intervention, only a minority seek professional help. The majority of those who do seek help are women; male students are less likely to associate somatic symptoms with emotional problems and are less willing to seek psychiatric help. The four case studies presented illustrate the clinical relevance of these research findings.     

Linking Self‐Regulation and Risk Proneness to Risky Sexual Behavior: Pathways through Peer Pressure and Early Substance Use

The linkages between self‐regulation in childhood, risk proneness in early adolescence, and risky sexual behavior in mid‐adolescence were examined in a cohort of children (N=518) from the National Longitudinal Survey of Youth. The possible mediating role of two early adolescent variables (substance use and negative peer pressure) was also examined. Self‐regulation was assessed by maternal report at ages 8–9, and risk proneness, comprising aspects of sensation seeking and decision making, was assessed by adolescent self‐report at ages 12–13. Structural equation models predicting risky sexual behavior at ages 16–17 indicated that self‐regulation operated partly through early adolescent substance use, whereas risk proneness operated through early adolescent substance use and negative peer pressure. The overall model did not differ significantly for boys and girls, although there were gender differences in the strength of particular paths. These long‐term longitudinal results support the importance of early self‐regulation and risk proneness in setting the stage for adolescent sexual risk taking and implicate substance use and negative peer pressure as processes through which risk proneness and poor self‐regulation lead to risky sexual behavior.     

Sexual Abuse and Sexual Functioning in a Chronic Pelvic Pain Sample

ABSTRACT

Sexual abuse, particularly childhood sexual abuse, has been linked to chronic pelvic pain and to sexual dysfunction, though the sexual functioning of survivors of sexual abuse has not been studied in a chronic pain population. Sixty-three women with chronic pelvic pain completed measures of sexual function, sexual abuse, and pain. Using an index of the extent of sexual abuse experiences in childhood and adolescence/adulthood, higher scores were related to lower rates of sexual activity, less satisfaction with orgasm and feelings of closeness with sexual partners, and greater severity of and interference from pain. Findings point to the importance of controlling for relationship status in analyses of long-term effects of sexual abuse and of assessing chronic pelvic pain patients for histories of sexual abuse using measures that address the extent or severity of abuse.     

Male Survivors of Childhood Sexual Abuse: A Qualitative Study and Issues for Clinical Consideration

ABSTRACT

This qualitative study explored the effects of childhood sexual abuse with 10 adult male survivors. The men who participated in the research were largely motivated by their perception that North American society does not acknowledge the sexual abuse of boys. They described the abuse as having significantly affected their sexual identity, as well as their emotional and sexual relationships as adults. The implications of these issues for clinical intervention are described.     

Eroticism in infancy and childhood∗

The capacity for sensate experience develops very early in life, begining prenatally. What the child lacks is opportunity, not capacity. Yet children are denied the full range of sexual experiences consistent with their capacity. At least this is true of children brought up in secretive and repressive societies.

On the other hand, the full range of cognitive capacity in humans does not emerge during childhood and is not available until adolescence at best. Management of the sexual life at a rational level appears difficult to attain for persons brought up in secretive repressive societies. Therefore much more thought and attention has to go into the development of quality sex education, education that takes into account the child's cognitive capacity plus any developmental lag in learning resulting from lack of prior sexual experience or the negative effects of furtive sexual encounters and negative parental reactions to such encounters.     

Predicting Time Spent in Treatment in a Sample of Danish Survivors of Child Sexual Abuse

ABSTRACT

The aim of this study was to identify significant predictors of length of time spent in treatment. In a convenience sample of 439 Danish survivors of child sexual abuse, predictors of time spent in treatment were examined. Assessments were conducted on a 6-month basis over a period of 18 months. A multinomial logistic regression analysis revealed that the experience of neglect in childhood and having experienced rape at any life stage were associated with less time in treatment. Higher educational attainment and being male were associated with staying in treatment for longer periods of time. These factors may be important for identifying those at risk of terminating treatment prematurely. It is hoped that a better understanding of the factors that predict time spent in treatment will help to improve treatment outcomes for individuals who are at risk of dropping out of treatment at an early stage.     

Cognitive and health-related outcomes after exposure to early malnutrition: The Leiden longitudinal study of international adoptees

BackgroundWe followed 190 internationally adopted children from infancy to young adulthood to examine the long-term consequences of early malnutrition on cognitive and health-related outcomes.MethodWe measured birth weight and physical condition in infancy, IQ and somatic problems in middle childhood, adolescence and young adulthood; in young adulthood, socioeconomic success was also assessed.ResultsEarly malnutrition negatively affected IQ in middle childhood and to a lesser extent IQ in young adulthood, but a negative effect on socioeconomic success was absent. Higher levels of early malnutrition predicted more somatic problems in middle childhood.ConclusionsVariation in early malnutrition explains differences in cognitive and health-related outcomes, with early malnutrition predicting lower IQs in middle childhood and in young adulthood. Early malnutrition did however not negatively affect the young adult's socioeconomic success, indicating that early malnutrition may be compensated by later experiences.     

Risk Factors and Life Processes Associated with Teenage Pregnancy: Results of a Prospective Study From Birth to 20 Years

Data gathered over the course of a 20‐year longitudinal study of 533 New Zealand women were used to (a) describe the extent and timing of pregnancies within the cohort up to age 20, and (b) examine the extent to which the risk of an early pregnancy was related to a range of social background, family, individual, and peer relationship factors measured over the course of childhood and adolescence. Results showed that by age 20, nearly a quarter of the sample had been pregnant at least once, with the majority of first pregnancies occurring between the ages of 17 and 20 years. The profile of those at greatest risk of a teenage pregnancy (<20 years) was that of an early‐maturing girl with conduct problems who had been reared in a family environment characterized by parental instability and maternal role models of young single motherhood. As young adolescents, these girls were characterized by high rates of sexual risk‐taking and deviant peer involvement. Exposure to social and individual adversity during both childhood and adolescence made independent contributions to an individual's risk of an early pregnancy. These findings were most consistent with a life course developmental model of the etiology of teenage pregnancy. Implications for teenage pregnancy prevention are discussed.