You can access the review of the long-term effects of sexual abusewritten by Paul Mullen and Jillian Fleming for the former National Child Protection Clearinghouse. More importantly, however, cross-sectional studies cannot differentiate "abuse-specific from abuse-concurrent or abuse-antecedent events" Briere,p. In a more recent Australian study, Moore et al.
Another important type of study is meta-analysis, a systematic review of a body of empirical studies that "looks at the within each study, and then calculates a weighted average" of the effect size across a of studies Cochrane Collaboration,p.
Similarly, Nelson et al. This can be problematic for several reasons. To what extent are the problems that sexually abused adolescent and adults exhibit a direct or indirect result of the sexual abuse, of other forms of co-existing abuse and family dysfunction, of pre-existing vulnerabilities and problems, or later problems that are not related to the sexual abuse? Of course, sexual abuse may not be revealed until later, and perhaps not at all, so weakening any comparison concerning the effects of sexual abuse. For example, in the case of family environment, child abuse may further disrupt an already dysfunctional family, and a dysfunctional family may be an important aspect of child abuse especially intra-familial sexual and physical abuse.
It is possible, for example, that "current distress or symptomatology" may affect the way earlier experiences are perceived and reported. First, causality cannot be inferred from correlational analyses and, as Briere pointed out, cause and effect can become blurred in correlational and retrospective des. Green et al. The support the multi-faceted model of traumatisation rather than a specific sexual abuse syndrome of child sexual abuse.
This allows an analysis of those cases where the abuse precedes the mental health outcome and overcomes the problem of retrospective recall but of course misses all those cases that do not come to official attention. One way of overcoming the need for retrospective reporting by those potentially victimised as children is to use cases where the abuse was disclosed in childhood and recorded in administrative data or medical or forensic records.
For consistency and clarity the current paper uses the term "victim" for the childhood experience and "survivor" for the adult experience or impact. There are a range of outcomes associated with child sexual abuse, related to mental health, behaviour and interpersonal relationships.
If you have been affected by child sexual abuse and are distressed, support services are available if you want to talk to someone. Child sexual abuse involving penetration has, in particular, been identified as a risk factor for developing psychotic and schizophrenic syndromes Cutajar et al.
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Thirty-seven studies published between andmostly US studies, involving 25, people were included. The main comparisons in these studies are within group comparisons, looking at the factors that differentiate between better versus poorer later outcomes. There are various ways of trying to control for the likely influence of other adversities in childhood as well as family background, and these include using matched or comparison groups and taking of these factors statistically. Studies on the prevalence and impact of sexual abuse vary in terms of the cut-off age used for "defining" childhood sexual abuse and the various characteristics of the abuse such as the types of sexual behaviours that are included.
Other important methodological considerations concern the definitions of child sexual abuse and the measurement of outcomes, and the need to take into other possibly "confounding" factors in disentangling the effects of related and other experiences on later outcomes.
The long-term effects of child sexual abuse
Several meta-analyses have been conducted in relation to the association between child sexual abuse and various adverse outcomes. Many studies in this field have relied on cross-sectional des whereby participants simultaneously provide information about their experience of abuse or not as well as their current outcomes such as their mental health or functioning. What do we know now about the long-term impact of child sexual abuse? The level of reporting of sexual abuse in childhood is also ificantly lower for people in older generations than for younger people Green et al.
In summary, research in this area has utilised a range of study des but recent research increasingly has used more rigorous des that take into possible confounding factors and use more standardised measures. Paolucci et al.
The most effective de to overcome these problems is a longitudinal prospective de in which a random selection of children is followed from birth. Noteworthy is a series of twin studies conducted over the last decade, which have consistently revealed a link between child sexual abuse and adverse mental health and related outcomes for survivors. However, there is also evidence that suggests some of these life experiences are likely to have been influenced by childhood sexual abuse itself or by the particular vulnerabilities of the child at the time.
It is important to be aware of the types of studies in which these findings have emerged, and to understand some of the methodological considerations and limitations of the research. As Mullen and Fleming outlined more than a decade ago, there is a consistent picture of ificant links between a history of child sexual abuse and a range of adverse outcomes both in childhood and adulthood. In addition, the child's family circumstances and context are important background and possibly protective factors. This paper outlines the findings of a range of research studies since then concerning mental health and functioning for survivors of child sexual abuse.
Other studies have relied upon official records for hospitalisation or psychiatric admissions, imprisonment, referral to child protection agencies for parenting problems or positive measures of educational achievement.
As Fergusson et al. Matching groups and using statistical means of equivalence are by no means foolproof, however, as Briere and Elliott pointed out:.
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These more rigorous studies have arguably generated more reliable and generalisable findings, despite the assessment of child sexual abuse still being predominantly retrospective in de Cutajar et al. It aims to assist practitioners and policy-makers who work with survivors of sexual abuse and their families to understand the ificant findings from this large and sometimes complex body of research.
The Dunne et al. It is important to understand how child sexual abuse is defined and how that may vary across a range of studies since this affects the way findings may be compared and the conclusions that can be drawn. This evidence comes from community and clinical samples, as well as epidemiological record-matching studies and several prospective longitudinal studies in various countries. Child sexual abuse covers an "array of sexual activities" with children Putnam,p. Research concerned with the links between child sexual abuse and later outcomes covers a broad range of areas and methodologies.
Paolucci, E. O, Genuis, M. Journal of Psychology1 A meta-analysis of published research on the effects of child sexual abuse for 6 outcomes: post-traumatic stress disorder PTSDdepression, suicide, sexual promiscuity, victim-perpetrator cycle, and poor academic performance.
The importance of the definitional issue is that the types of sexual abuse that are included will affect the findings in relation to outcomes, not just prevalence. This allows a comparison between those who experience various forms of abuse, including sexual abuse, and those who were not abused at all. There is a range of "specialised populations" that provide evidence for a link between child sexual abuse and later outcomes. The best known substantial prospective longitudinal study which provides useful findings in this field is the Christchurch Health and Development Study CHDSa longitudinal study of a birth cohort of 1, children born in the Christchurch New Zealand urban region in mid, with information from a variety of sources including: parental interviews, teacher reports, self-reports, psychometric assessments, medical, and other record data.
This of course means that any association with later outcomes is tied up with the disclosure experience and subsequent events connected with the formulation of these records. It starts with a discussion of the methodological issues posed by this area of research and concludes with some of the gender differences and conceptual challenges presented by the findings of this body of research.
These include the relationship between the child and the perpetrator, the age and gender of both the child and perpetrator, and the frequency, duration and form of the abuse. Twin studies, involving one twin known to have been abused and the other not, provide a particularly strong research de because they provide a comparison that controls for family background for twins raised together, and also genetic make-up for identical versus mono-zygotic twins Dinwiddie et al.
The effects were strongest for drug and alcohol dependence and bulimia nervosa. Clearly, it is easier and more reliable to compare the findings from studies that use commensurate measures.
As Briere pointed out, it is likely that studies which use a definition of sexual abuse that is restricted to more intrusive and severe forms of abuse involving penetration will report more severe adverse outcomes than those using broader definitions. Determining the association between children's experiences of sexual abuse and later outcomes is not straightforward.
Attrition or the loss of participants to the study also reduces the power of the analyses, and there is still the need to take of other factors apart from abuse that may contribute to adverse outcomes. As outlined later, for example, children who have been sexually abused are more likely than other children to be re-victimised both as adolescents and adults.
These special populations include those who have been referred for counselling, those attending specialised clinics, those seeking medical or psychiatric treatment, those in prison or detention, child victim-witnesses child victims who have been through the legal processand university or college students.
Studies concerned with the short- and longer-term outcomes associated with child sexual abuse cover a diverse range of outcomes, including mental health and functioning, behavioural outcomes, interpersonal and social outcomes, educational outcomes, and increasingly, physical health and brain development.
As a result, controlling for family environment when examining the relationship between abuse and later psychological symptoms may be a highly conservative, or even nonsensical procedure e.
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This paper reviews recent Australian and international research on the long-term effects of child sexual abuse. Most studies rely on the retrospective recall of adults about their childhood experience, often because of the ethical issues of asking children to answer questions about sexual abuse and sexual activity while they are still children. There were no statistically ificant differences or effect size when various potentially mediating variables such as gender, socioeconomic status, type of abuse, age when abused, relationship to perpetrator, and of abuse incidents were assessed.
There is a similar picture of diversity with the use of some standardised measures in relation to other types of outcomes as well. Kendler et al.
For further information on the definition of child sexual abuse and other child maltreatment subtypes see What is Child Abuse and Neglect? While much of the earlier research in this area used cross-sectional studies with clinical or convenience samples, more recent studies have increasingly used large random community samples, birth and twin cohorts. As Kendall-Tackettamong others, has pointed out, child abuse is related to "health via a complex matrix of behavioural, emotional, social, and cognitive factors" which relate to a complex array of outcomes p.
Dinwiddie et al. It is also possible that "abuse-related symptomatology can wax and wane across the life span", particularly in relation to current life experiences and developmental stages with the emergence, for example, of intimacy and sexual problems in adolescence or "sleeper effects" later in adulthood with the birth of Briere,pp.
There is likely to be some bias in recall and error in these retrospective reports, which rely on the willingness of the respondent to report on them at that time. Fergusson, Horwood, and Woodwardfor example, found that when they asked the participants aged years in their longitudinal study "whether, before the age of 16, anyone had ever attempted to involve them in any of a series of 15 sexual activities when they did not want this to happen", 1 there was "considerable instability and change" between the responses given to this question at 18 years of age and 3 years later at age 21, several years after the cut-off age of While there was no evidence to suggest that these reports were influenced by the psychological state of participants at the time, it does indicate that using different ages for retrospective reporting is likely to provide different.
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For example, in an early Australian prevalence study, Goldman and Goldman defined child sexual abuse as "some form of sexual abuse or exploitation by age 18 years by a person five or more years older" that included behaviours such as: "being hugged in a sexual way", "adult showing genitals" and being "invited to do something sexual" p. In a critical review of 29 earlier studies in which adult retrospective reports of more than one form of child maltreatment sexual abuse, physical abuse, psychological maltreatment, neglect, or witnessing family violence were assessed, Higgins and McCabe found that "the specific impact of multi-type maltreatment … was associated with greater impairment than single forms of abuse or neglect" p.
Other studies, including a reputable large-scale study in Victoria Australia Cutajar et al.
At the most serious extreme of mental health problems, the findings related to suicide ideation, suicide attempts and actual suicides are of particular concern, especially since the Victorian Parliamentary Inquiry into the Handling of Child Abuse by Religious and Other Organisations was instituted at least partly on the basis that 40 Victorian people allegedly abused by Catholic clergy had committed suicide in recent years.
Other likely ificant contributing and possibly confounding factors for long-term outcomes include the person's more recent and current circumstances and life experiences. Different studies may use different measures for similar outcomes.
An important methodological issue is the need to disentangle the effects of abuse from other influences by taking of a range of individual, family and social factors that might affect or contribute to adverse long-term outcomes.
In addition, studies vary as to how the relationship between the victim and the perpetrator is categorised often as "within the family" and "outside the family". Those in detention or in prison or seeking psychiatric treatment are clearly sub-populations showing adverse outcomes, but the question is to what extent is this related to their experience of sexual abuse?
Please note: The content in this report contains information that may cause distress to some readers. There has also been more attention to the scientific rigour of studies and to the conceptual underpinnings of these effects. The main focus in this paper is on mental health functioning and behaviours and interpersonal aspects.