A review of the epidentiological research on child sexual abuse. Community and college student samples

This article is the first of two consecutive reviews on the major empirical studies which have been carried out in an attempt to estimate the prevalence of child sexual abuse among females. The research is structured in terms of three sample categories: (a) probability and non-probability samples of the general population; (b) college student samples; and (c) clinical inpatient and outpatient samples. This part of the review deals with (a) and (b) and highlights a number of unresolved methodological issues which may contribute to the variance in reported prevalence rates. These include a myriad of definitions of child sexual abuse and different methods of eliciting information on possible histories of abuse. Despite these problems. taken as a whole the prevalence studies indicate the significant numbers of people who have experienced abuse and who are willing to disclose aspects of these abusive experiences.     

Forensic, cultural, and systems issues in child sexual abuse cases--part 2: research and practitioner issues

This article introduces the second issue of the special double issue focusing on forensic, cultural, and systems issues in child sexual abuse cases. We briefly review the articles, which include a discussion of child sexual abuse myths, an empirical analysis of extended child sexual abuse evaluations, an article on the role of the medical provider in child sexual abuse evaluations, a study of satisfaction levels with multidisciplinary teams in child advocacy centers, and a commentary advocating for the credentialing of forensic interviewers. We call for further empirical examination of media related to child sexual abuse risk, research on appropriate models for extended sexual abuse interviews and evaluations, and optimal practices relevant to each member of multidisciplinary teams in a child advocacy center.     

Child Sexual Abuse News: A Systematic Review of Content Analysis Studies

Public knowledge and attitudes toward child sexual abuse are shaped through media depictions and coverage. Since the media are the main source of information about child sexual abuse, studies of child sexual abuse news can help us understand how news is created, how child sexual abuse is presented to the public, and what is the possible impact of such presentation and coverage on the audience. A systematic review of content analysis research is conducted using predefined criteria in order to identify quality studies, main findings, research gaps and to develop recommendations for future studies. International databases were systematically searched using keywords in September 2017. A total of 24 original quantitative content analysis studies published in the English language were included in the review and evaluated according to research methodology. The framework of child sexual abuse news media studies is developed and main findings are highlighted: (1) presentation and coverage of child sexual abuse (n = 7); (2) prevalence of coverage of CSA cases reported to the authorities (n = 2); (3) presentation and coverage of child abuse and sexual crimes where child sexual abuse is only a subtopic (n = 9); (4) presentation and coverage of specific child sexual abuse cases or issues (n = 6). Although studies represent valuable contribution, most did not meet content analysis design and reporting standards or both (e.g., calculating intercoder reliability), which seriously compromises validity and replicability requirements. Recommendation for future studies and most common errors in conducting content analysis are emphasized.     

Self Psychology and Male Child Sexual Abuse: Healing Relational Betrayal

The prevalence of male child sexual abuse (MCSA) is higher than initially thought with up to 26 % of men in community samples reporting sexual abuse in childhood, and up to 36 % of men in clinical samples reporting childhood sexual abuse. Disclosure of MCSA is complex because of men’s difficulties in viewing themselves as victims, especially of sexual violence. This difficulty is exacerbated by societal attitudes that sexual abuse rarely occurs with boys, and is further complicated with the taboo of victimization by same sex perpetrators. Too often, the response to disclosure is disbelief and minimization. For these reasons disclosure is often delayed or withheld thus prolonging the abuse. The negative effects of child sexual abuse are well documented and far reaching with depression, anxiety, post-traumatic stress disorder, addictions, sexual dysfunction and impaired interpersonal relations as common presenting issues in therapy. Treatment is indicated for significant numbers of male survivors. This paper identifies aspects of interpersonal relational difficulties commonly experienced by male sexual abuse survivors, and describes self psychology as guiding a clinical approach to address these interpersonal difficulties. The application of self psychology with male sexual abuse survivors is traced and discussed through the use of a clinical case study with Adam.     

Breaking the Silence of Child Sexual Abuse in the Caribbean: A Community-Based Action Research Intervention Model

In Trinidad and Tobago, little data exists on child sexual abuse, although there are many anecdotal reports of high prevalence. The Breaking the Silence Gender and Community Empowerment Model is a multidisciplinary intervention to prevent and respond to child sexual abuse in Trinidad and Tobago. It is an innovative, gender-sensitive intervention that uses a community based action research methodology anchored in a national framework. Preliminary evaluation of the Breaking the Silence model shows increased knowledge of child sexual abuse, increased willingness to discuss child sexual abuse, and an impact that goes beyond the target communities. This model can be replicated in communities to prevent and respond to child sexual abuse and adapted to address other sensitive social issues in the Caribbean.     

A Review of Child Sexual Abuse: Impact,Risk, and Resilience in the Context of Culture

Child sexual abuse is a problem with both a national and worldwide prevalence. In this review, the authors note that while empirical research has clearly shown the negative impact of child sexual abuse on social, psychological, and sexual functioning later in life, it has also been reported that some individuals remain asymptomatic despite a history of experiencing child sexual abuse. This implies that negative outcomes later in life are not inevitable and illustrates the critical need to elucidate how resilience may moderate the negative impacts of child sexual abuse. In addition to emphasising the role of resilience, this review also underscores the important role that cultural context plays in understanding child sexual abuse, as there are known risk factors and protective factors specific to different cultures. Similarly, one’s culture may also influence whether abuse is reported and addressed, and the topic is given special attention in this paper because it is not widely discussed within the existing literature. The impact of child sexual abuse on mental health, sexual health, and social functioning is also discussed.     

Child sexual abuse myths: attitudes, beliefs, and individual differences

Child sexual abuse myths comprise incorrect beliefs regarding sexual abuse, victims, and perpetrators. Relations among myth acceptance, responses to disclosure, legal decisions, and victims' subsequent psychological and health outcomes underscore the importance of understanding child sexual abuse myths. Despite accurate knowledge regarding child sexual abuse among many professional and other individuals, child sexual abuse myths persist. A Google search produced 119 child sexual abuse myths, some with overlapping themes. Coders grouped myths into four categories: (a) minimizations or exaggerations of the extent of harm child sexual abuse poses, (b) denials of the extent of child sexual abuse, (c) diffusions of perpetrator blame, and (d) perpetrator stereotypes. This review provides available data regarding the prevalence for these myths, empirical research that refutes or confirms myth categories, and considerations of cultural contexts and implications.     

Part II: Differences between Sexually Victimized and Nonsexually Victimized Male Adolescent Sexual Abusers and Delinquent Youth: Further Group Comparisons of Developmental Antecedents and Behavioral Challenges

In order to determine the prevalence of childhood sexual abuse among gay, lesbian, and bisexual individuals, we conducted a meta-analysis that compiled the results of 65 articles across 9 countries. The results revealed no significant difference in the prevalence of child sexual abuse between homosexual and bisexual people for both sexes. The prevalence of child sexual abuse among female sexual minorities was significantly higher than that among male sexual minorities. The lowest prevalence was found in South America, followed by Asia. The definition of child sexual abuse, dimension used to measure sexual orientation, year of data collection, and the mean age of participants at the time of assessment influenced the estimated prevalence of child sexual abuse. We conclude that many variables influence the reported prevalence of child sexual abuse among sexual minorities.     

Prevalence of Childhood Sexual Abuse in China: A Meta-Analysis

The objective of the current study was to explore the estimated prevalence of childhood sexual abuse in China. We conducted a meta-analysis that used the data from 36 articles. A total of 125 independent samples and 131,734 participants were included. The results revealed no significant difference in the prevalence of childhood sexual abuse between Chinese men (9.1%) and women (8.9%). The prevalence of childhood sexual abuse in studies from mainland areas was significantly higher than that from Hong Kong/Taiwan. The estimated prevalence of childhood sexual abuse in China also differed according to the definition of child sexual abuse, data collection method, year of data collection, and the mean age of participants at the time of assessment.     

Prevalence of Child Sexual Abuse in the Nordic Countries: A Literature Review

This review examined child sexual abuse in the Nordic countries focusing on prevalence rates and victims’ age and relationship to the perpetrator. The results show a prevalence of child sexual abuse (broadly defined) between 3–23% for boys and 11–36% for girls. The prevalence rates for contact abuse were 1–12% for boys and 6–30% for girls, while 0.3–6.8% of the boys and 1.1–13.5% of the girls reported penetrating abuse. The findings suggest an increased risk of abuse from early adolescence. In adolescence, peers may constitute the largest group of perpetrators. The results highlight the need for preventive efforts also targeting peer abuse. Future research should include cross-national and repeated studies using comparable methodology.     

Child Sexual Abuse and Adult Mental Health,Sexual Risk Behaviors,and Drinking Patterns Among Latino Men Who Have Sex With Men

One in five Latino men who have sex with men has experienced child sexual abuse. Although concerning in itself, child sexual abuse may increase an individuals’ likelihood of depression and risk-taking in adult life, including engagement in HIV risk behaviors and alcohol and substance use. It is therefore urgent that researchers and practitioners better understand the long-term effects of child sexual abuse. We utilized logistic and linear regression to assess associations between child sexual abuse (operationalized as forced or coerced sexual activity before age 17) and depression, sexual behaviors, and drinking patterns in a sample of 176 adult Latino men who have sex with men from New York City. Over one-fifth (22%) of participants reported child sexual abuse. In multivariable models, participants with histories of child sexual abuse were significantly more likely than participants without such histories to screen for clinically significant depressive symptoms and heavy drinking and reported more anal sex acts, male sexual partners, and incidents of condomless anal intercourse in the previous three months. These findings confirm a high prevalence of child sexual abuse among Latino men who have sex with men and associations between child sexual abuse and adulthood depressive symptoms, high-risk alcohol consumption, and sexual risk behaviors. We recommend that providers who serve Latino men who have sex with men incorporate child sexual abuse screenings into mental health, HIV prevention, and substance use treatment programs, utilizing approaches that are inclusive of resilience.     

Prevalence,Characteristics, and Associations of Sexual Abuse with Sociodemographics and Consensual Sex in a Population-Based Sample of Swedish Adolescents

The purpose of this study was to investigate lifetime prevalence and characteristics of self-reported child sexual abuse and associations between child sexual abuse, gender, sociodemographic data, and consensual sexual experiences. A questionnaire was completed by 4,339 Swedish high school seniors. Three categories of child sexual abuse were studied: noncontact, contact without penetration, and penetrating child sexual abuse. Penetrating child sexual abuse was correlated with the most severe abuse characteristics. Students reporting child sexual abuse, especially penetrating child sexual abuse, were more likely to not be living with both parents, to have parents with lower socioeconomic status, and to have their first consensual intercourse at a young age. The study showed that distinct categories of child sexual abuse must be employed since each category shows a specific pattern concerning abuse characteristics, sociodemographics, and consensual sex.     

UK Paramedics Confidence in Identifying Child Sexual Abuse: A Mixed-Methods Investigation

United Kingdom (UK) paramedics are in a prime position to identify children and young people who are victims or at risk of sexual abuse. Paramedics have access, by phone, or in person, to unprepared homes and communities which other health professionals such as social workers may not. Little research exists however, investigating UK paramedic confidence in identifying child sexual abuse. This mixed-method explanatory sequential investigation used the self-reported confidence levels of 276 UK paramedics to inform the design of seven semi-structured focus groups with 25 UK paramedics from a large ambulance service with operating models similar to all UK services. Multiple factors contribute to a lack of confidence in identifying child sexual abuse, child sexual exploitation, and female genital mutilation, including a perceived lack of exposure to sexual abuse, the perceived hidden nature of sexual abuse, and the lack of physical symptoms and examination. An overarching lack of knowledge is the most significant contributor to a lack of confidence which in turn perpetuates misinformation surrounding prevalence, location, and the signs and symptoms of sexual abuse. These findings suggest a lack of sufficient training and a need for further research evaluating the content of current training and its method of delivery.     

Prevalence of Sexual Trauma History Using Behaviorally Specific Methods of Assessment in First Year College Students

There are several challenges associated with evaluating the prevalence of sexual trauma, including child sexual abuse and adult sexual assault. The aim of this study was to assess sexual trauma prevalence rates among first year college students (N = 954) using behaviorally specific questions and a more representative recruitment sample that did not rely on self-selection. Participants completed a list of sexual trauma questions, including general questions containing labels such as “rape” or “abuse” as well as behaviorally specific questions that describe specific behaviors that qualify as sexual trauma without labels. Results indicated that 6.7% of the sample reported at least one incident of child sexual abuse, with similar rates for men and women. Women were more likely to report a history of adult sexual assault, which was reported by 12.4% of the total sample. Participants were also more likely to endorse a history of sexual trauma when answering behaviorally specific rather than general “label” questions. Women survivors in particular were more likely than men to identify their experiences as abuse/assault (66.7% versus 21.1% for child sexual abuse), which may help explain prevalence differences between men and women in prior research. Men may be less likely than women to label their experiences as abuse and may be underidentified in sexual trauma research without the use of behaviorally specific questions. Overall, the results of this study suggest that the prevalence of sexual trauma is better assessed using behaviorally specific questions and that this is an important topic of study among both men and women.     

Child sexual abuse in Sri Lanka: the current state of affairs and recommendations for the future

This article focuses on child sexual abuse in Sri Lanka. The background of child sexual abuse in the country and its current status are discussed. The role of the National Child Protection Authority, the primary governmental body concerned with child protection, is also explored. The article also brings to light various cultural dimensions that serve to call attention to the issue of sexual abuse of children in Sri Lanka. These are explored and illustrated with case vignettes from the author's clinical experience. Finally, the article elucidates the main issues and barriers in Sri Lanka that need to be surmounted in order to have an integrated service delivery in the care of the sexually abused child.     

The prevalence and nature of child sexual abuse: evidence from a female university sample in the UK

It is well established that child sexual abuse is a considerable international problem, yet evidence regarding its prevalence in the United Kingdom is extremely sparse, with the most comprehensive study conducted over a decade ago. The aim of this study is to establish a current estimate of the prevalence and nature of child sexual abuse in the United Kingdom, using a sample of female university students. Of the 213 female undergraduate students who completed questionnaires, 28 were sexually abused, giving a prevalence rate of 13.14%. Information was also obtained regarding the nature of the abuse. These results show that a substantial proportion of female students in the United Kingdom, who appear to be coping with tertiary education, have been sexually abused in childhood. The implications regarding the benefits of prevalence rates to health practitioners are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

How Do Adult Survivors of Childhood Sexual Abuse Experience Formally Delivered Talking Therapy? A Systematic Review

This systematic review explored how adult survivors of child sexual abuse experienced nonspecific and trauma-focused talking therapies. Following extensive systematic searches of academic databases, 23 qualitative empirical studies were chosen for review. Using a line-by-line thematic synthesis, four analytical themes developed. These themes were: The Therapeutic Process as a Means for Forming Connections, which discusses therapeutic relationships; Developing a Sense of Self Through the Therapeutic Processes, which identifies stages of developmental recovery; Therapeutic Lights and Black Holes in the Shadows of child sexual abuse, which reflects on how a history of child sexual abuse influenced experiences of therapy; and Healing or Harrowing: Connecting With Others and First-time Experiences, which explores what was helpful, hindering, and new throughout the therapeutic journey. Findings related to participants developing new options for interpersonal relationships through the experience of authentic trust and the experiential learning of control and choice. Recommendations are discussed in relation to developing therapeutic practice and future research.