A Psychosocial Understanding of Child Sexual Abuse Disclosure Among Female Children in South Africa

Child sexual abuse is endemic in South Africa, driven by high levels of gender-based violence and underscored by structural and social factors. This article aims to develop an understanding of the process of disclosure in a sample of female children and their caregivers. In-depth semistructured interviews were conducted with 31 female children aged 8–17 years and their caregivers at 3 intervals after presentation to a sexual assault treatment center. Nearly half of the children failed to disclose the sexual abuse immediately, fearing caregivers’ reaction. Most children purposefully disclosed to a confidant through a process of identifying an intermediary to tell caregivers on their behalf. The process of disclosure was influenced by multiple factors, such as a fear of the caregiver’s reaction and disbelief, which is related to parental style. Disclosure was found to be a dynamic process that unfolds and not a single or static event and influenced by multiple factors which all impact on recovery. Our findings highlight the need to address social norms on sexual abuse in order to improve responses to disclosure to facilitate post-sexual-abuse adjustment for the child and the family.     

Self-rated Health in Relation to Rape and Mental Health Disorders in a National Sample of College Women

Abstract

Objective: The purpose of this study was to employ a multivariate approach to examine the correlates of self-rated health in a college sample of women, with particular emphasis on sexual assault history and related mental health outcomes. Participants: A national sample of 2,000 female college students participated in a structured phone interview between January and June 2006. Methods: Interview modules assessed demographics, posttraumatic stress disorder, major depressive episode, substance use, rape experiences, and physical health. Results: Logistic regression analyses showed that poor self-rated health was associated with low income (odds ratio [OR] = 2.70), lifetime posttraumatic stress disorder (OR = 2.47), lifetime major depressive episode (OR = 2.56), past year illicit drug use (OR = 2.48), and multiple rape history (OR = 2.25). Conclusions: These findings highlight the need for university mental health and medical service providers to assess for rape history, and to diagnose and treat related psychiatric problems in order to reduce physical morbidity.     

The Effect of Severe Child Sexual Abuse and Disclosure on Mental Health during Adulthood

This study examined the relationship among severe child sexual abuse, disclosure, and mental health symptoms during adulthood. The sample consisted of 172 adults who were sexually abused in childhood. The multivariate model showed that respondents in their 30s and 40s who were abused by more than one abuser, who were injured by their abusers, who were abused by a biological relative, who told someone about the abuse when it occurred, and who did not discuss their abuse in depth within one year of the abuse had a greater number of mental health symptoms. Abuse severity and disclosure history should be assessed by professionals to identify clients who are at higher risk of mental health symptoms and to focus therapy.     

Analysis of HIV Caregivers in South Africa: A South African Depression and Anxiety Group

ABSTRACT

The severity of the HIV/AIDS epidemic in South Africa is well documented. However, little is known regarding the well-being of caregivers of persons with HIV/AIDS in South Africa. This study sought to evaluate characteristics, similarities and differences between groups of HIV caregivers in rural, semi-rural, and urban areas of South Africa. Interesting trends were noticed in the areas of suicidality, alcohol abuse, and intimate trauma. Findings indicate a substantial need for further study in the area of suicidality, denial of or lack of desire to know HIV status and the accompanying diagnostic stigma, and the need for a support network within lay caregivers.     

Post-Traumatic Stress Disorder and Quality of Life in Sexually Abused Australian Children

The study used publicly available data on post-traumatic stress disorder in a sample of the Australian population with a history of sexual abuse to demonstrate how this evidence can inform economic analyses. The 2007 Australian Mental Health Survey revealed that 8.3% of 993 adolescents experienced childhood sexual abuse, of which 40.2% were diagnosed with post-traumatic stress disorder. Post-traumatic stress disorder diagnosis corresponded to a significant loss of quality of life. Survival analysis was used to estimate the lifetime persistence of post-traumatic stress disorder symptoms. The average time between post-traumatic stress disorder onset and remission was 11.4 years. Results suggest that successful treatment of post-traumatic stress disorder will save 2.05 quality adjusted life years per child or adolescent with post-traumatic stress disorder.     

Post-Traumatic Stress Disorder,Dissociation, and Neuropsychological Performance in Latina Victims of Childhood Sexual Abuse

This study compared the memory, attention/concentration, and executive functioning of 12 women with histories of child sexual abuse with a control group of 12 women without childhood abuse. Participants completed a neuropsychological test battery and various instruments assessing post-traumatic stress disorder and dissociation. The child sexual abuse group had lower performance than the control group on long- and short-term visual and verbal memory and presented more limited performance on executive functioning tasks. Functioning in these areas showed a negative correlation with post-traumatic stress disorder and dissociative symptoms. These findings suggest that child sexual abuse is associated with memory and executive functioning deficits and supports the idea that people with trauma histories and increased post-traumatic stress disorder and dissociation symptoms may have alterations in neuropsychological functioning.     

Mental Health and Behavioral Outcomes of Sexual and Nonsexual Child Maltreatment Among Child Welfare-Involved Youth

Our research team used the nationally representative National Survey of Child and Adolescent Well-Being II to explore the differences in mental health and behavioral outcomes between children who enter the child welfare system with substantiated sexual abuse and those who enter with exclusively nonsexual maltreatment. The sample included 380 children between the ages of 8 to 17.5 who were substantiated for maltreatment (sexual and nonsexual) and had the same caregivers at both wave 1 and 2 (n = 380). Results show that the average age of children in the sample was 11 years old, and the results corroborate literature that has indicated children and youth with histories of childhood sexual abuse experience significantly more post-traumatic stress disorder symptoms than children with histories of nonsexual maltreatment. This finding held after controlling for baseline trauma symptoms and all covariates, including race, age, placement type, and caregiver characteristics. Childhood sexual abuse was not significantly related to an increase in behavioral symptoms after controlling for covariates. Implications for research and practice are offered.     

Exploring the Context of Child Sexual Abuse in Jamaica: Addressing the Deficits

Jamaican media sources have recently noted the prevalence of child sexual abuse within the country. While research has continually noted the mental health impact of child sexual abuse, there is a dearth of literature on the relationship between the two in Jamaica. The purpose of this article is to provide the context of child sexual abuse in Jamaica, including the cultural considerations, current legislation, government created agencies, and modes of treatment. Moreover, recommendations are given for public health educators, school personnel, and mental health service providers in order to improve the psychological well-being of sexually abuse children.     

Community-based psychosocial rehabilitation for schizophrenia service users in the north west province of South Africa: A formative study

Psychosocial support is recognized as important for recovery for service users with schizophrenia, in addition to provision of antipsychotic medication. This study aimed to develop a community-based psychosocial rehabilitation programme for service users with schizophrenia to be facilitated by auxiliary social workers, and to investigate acceptability and feasibility of the programme. A task-sharing approach was adopted in which auxiliary social workers were trained to facilitate psychosocial rehabilitation groups. In-depth individual qualitative interviews were conducted with six group members at baseline, midpoint, and endpoint (18 interviews in total). NVivo10 was used to store data and conduct qualitative framework analysis. Participants reported benefits of the programme, including improvements in group members’ self-esteem, social support, illness knowledge, self-care, and contribution to their households. A key barrier to acceptability was the lack of provision of income generating opportunities. Implementation challenges include difficulties in tracing and engaging service users and families, lack of an appropriate venue, and issues with supply of antipsychotic medication. This study has provided evidence for the benefits and acceptability of this contextually adapted programme. Key barriers to implementation can be addressed through the provision of the necessary resources for auxiliary social worker input in the community.     

Caregivers' Endorsement of Barriers to Mental Health Services for Children and Youth in Child Welfare

The purpose of this study was to examine the three most common types of caregivers in the child welfare system (birth parents, relative caregivers, and foster parents), an active child welfare case, caregivers' endorsement of barriers to mental health services and mental health service use by caregivers for the children under their care. The sample consisted of 430 dyads (caregivers and their children). Results indicate that an active child welfare case, provider characteristics, and accessibility of services predicted mental health service use for children. Implications for the child welfare and mental health systems are discussed.     

Mental Health Knowledge Gaps in the Child Protection Work with Parents: A Narrative Review of the Social Work Literature

This is a narrative review of the latest peer-reviewed social work literature on the child protection work with parents. Aiming to identify knowledge gaps, the study researches the mental health aspects of the implicit or explicit theoretical perspectives underpinning the assessment and intervention with parents. An electronic database search extracted 38 peer-reviewed journal articles. It was found that the theoretical perspectives the publications adopted were the managerial, the critical, the humanistic, the psychodynamic and the behavioural. The study identified mental health knowledge gaps in the assessment and intervention work with parents across all theoretical perspectives and stressed the need for process and effectiveness studies on the work with parents, under explicit theoretical perspectives. The study finally highlights the need for the social work profession to increase its mental health literacy through mental health education for students and practitioners alike.     

Perpetration,Revictimization, and Self-Injury: Traumatic Reenactments of Child Sexual Abuse in a Nonclinical Sample of South African Adolescents

Risk factors for traumatic reenactments of child sexual abuse experiences (perpetration, revictimization, and self-injury) were examined in a sample of 718 South African secondary school adolescents. Logistic regression analyses indicated that the most consistent predictors of reenactments were a history of child sexual abuse (rape and/or indecent assault) and respondents’ gender, with males being significantly more likely than females to report perpetration (OR = 13.5) and females being more likely to report revictimization (OR = 3.2) and self-injury (OR = 2.5). An analysis restricted to respondents with a history of child sexual abuse indicated that negative abuse-related cognitions were the most consistent predictor of all forms of traumatic reenactment.     

Child Welfare and Juvenile Justice: Examining the Unique Mental Health Needs of Girls

This study investigated the prevalence of mental health problems among girls who are involved in child welfare or juvenile justice systems. The sample consisted of 1,193 girls ranging in age from 4 to 18, the majority (82.3%, n = 982) of which were older than age 12. Differences based on race/ethnicity and developmental age groups were examined. Consistent with other research, this study found that the mental health needs of girls involved in the child welfare or juvenile justice systems are several times higher than in the general population. Intervention approaches must be developed that take into consideration differences in gender, age, and racial and ethnic group.     

Posttraumatic Stress and Depression in the Nonoffending Caregivers of Sexually Abused Children: Associations With Parenting Practices

Caregiver mental health is a known correlate of parenting practices, and recent research indicated that parental depression following childhood sexual abuse disclosure is associated with concurrent parenting difficulties. The present study extended this line of research by investigating posttraumatic stress symptoms and depression in a sample of caregivers (N = 96) of children who experienced sexual abuse recruited from a child advocacy center as well as parenting practices reported by both caregivers and their children (mean age = 10.79 years, SD = 3.29; 79% female). Twenty-four percent of caregivers met criteria for presumptive clinical depression, clinically significant posttraumatic stress, or both. Results indicated elevated caregiver-reported inconsistent parenting in the context of clinically significant distress across symptom groups; children reported particularly elevated inconsistent parenting for caregivers with posttraumatic stress only. Caregiver depression was associated with low self-reported positive parenting and caregiver involvement in addition to self-reported inconsistencies. Directions for future research are offered to further elucidate the relationships between caregiver mental health and parenting practices following childhood sexual abuse.     

Effects of Testosterone Treatment and Chest Reconstruction Surgery on Mental Health and Sexuality in Female-To-Male Transgender People

ABSTRACT. Objectives: This study examined the effects of testosterone treatment with or without chest reconstruction surgery (CRS) on mental health in female-to-male transgender people (FTMs). Methods: More than 200 FTMs completed a written survey including quantitative scales to measure symptoms of anxiety and depression, feelings of anger, and body dissatisfaction, as well as qualitative questions assessing shifts in sexuality after the initiation of testosterone. Fifty-seven percent of participants were taking testosterone and 40% had undergone CRS. Results: Cross-sectional analysis using a between-subjects multivariate analysis of variance showed that participants who were receiving testosterone endorsed fewer symptoms of anxiety and depression as well as less anger than the untreated group. Participants who had CRS in addition to testosterone reported less body dissatisfaction than both the testosterone-only or the untreated groups. Furthermore, participants who were injecting testosterone on a weekly basis showed significantly less anger compared with those injecting every other week. In qualitative reports, more than 50% of participants described increased sexual attraction to nontransgender men after taking testosterone. Conclusions: Results indicate that testosterone treatment in FTMs is associated with a positive effect on mental health on measures of depression, anxiety, and anger, while CRS appears to be more important for the alleviation of body dissatisfaction. The findings have particular relevance for counselors and health care providers serving FTM and gender-variant people considering medical gender transition.     

A Social Constructivist Perspective on the Potential Relevance of Selected DSM‐5 Disorders for South African Children and Youth

In South Africa, careless implementation of child psychiatry's biomedical model of ‘mental disorder’ could stigmatise children and youth who have been made vulnerable by the lingering effects of apartheid — poverty and malnutrition, violence and abuse, and the HIV/AIDS pandemic. A focus on DSM‐5 category changes — regarding post‐traumatic stress disorder and ADHD — demonstrates that these psychiatric labels are impracticable and irrelevant in a post‐colonial developing country, where mental health care is delivered in the context of scarce services and unequal access. A social constructivist perspective enables us to broaden policy decisions and suggest directions for research.     

Is Partner Violence Worse in the Context of Control?

M. P. Johnson’s (1995) proposal that there are two qualitatively distinct types of intimate partner violence—intimate terrorism and situational couple violence—has been an influential explanation for disparate findings on sex symmetry in domestic violence. This study examines whether this typology increases our ability to explain variations in the negative outcomes of partner violence as compared with the use of a continuous measure of violence. This study also considers whether the use of control to differentiate between types of violence helps to explain the negative consequences of partner violence. The results, based on analyses of data on 4,575 married women from National Violence Against Women survey, indicate mixed support for Johnson’s argument for a qualitative distinction between IT and SCV.