Self-reported and agency-notified child sexual abuse in a population-based birth cohort.
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ABSTRACT:
SUBMITTER: Mills R
PROVIDER: S-EPMC4744520 | biostudies-literature | 2016 Mar
REPOSITORIES: biostudies-literature
Publications
Self-reported and agency-notified child sexual abuse in a population-based birth cohort.
Mills Ryan R Kisely Steve S Alati Rosa R Strathearn Lane L Najman Jake J
Journal of psychiatric research 20151228
Child sexual abuse (CSA) has been associated with many adverse psychiatric outcomes. However, most studies have relied on retrospective self-report of exposure to CSA. We set out to investigate the incidence of CSA in the same birth cohort using both retrospective self-report and prospective government agency notification, and examine the psychological outcomes in young adulthood. The primary outcomes were measures of DSM-IV diagnoses (CIDI-Auto) at age 21. The 21-year retrospective CSA question ...[more]
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Project description:BackgroundWe aim to determine whether adult retrospective report of child abuse is associated with greater risk of prospectively assessed harmful environments in childhood. We assessed possible recall basis by adult depression status.MethodsAt 45 years, participants of the 1958 British birth cohort (N = 9308) reported a range of abuse types (by 16 years). Prospective data, ages 7-16 years, were obtained for impoverished upbringing, hazardous conditions, anti-social behaviours and 16 years poor parent-child relationships. We estimated associations between retrospective report of child abuse and prospectively measured harm using (i) odds ratios (ORs, 95% confidence intervals) and (ii) positive predictive values (PPVs). PPVs were calculated stratified by adult depression status.ResultsPrevalence of retrospectively reported abuse ranged from 10.7% (psychological) to 1.60% (sexual) and 14.8% reported ≥ 1 type; prospectively recorded harm ranged from 10% (hazardous conditions/poor parent-child relationships) to 20% (anti-social behaviours). Adults retrospectively reporting abuse were more likely to have had harmful childhood environments: 52.4% had ≥ 1 indicator of harm (vs. 35.6% among others); ORsex-adjusted for poor relationships with parents was 2.98 (2.50, 3.54). For retrospectively reported (vs. none) abuse, there was a trend of increasing relative risk ratio with number of harms, from 1.75 (1.50, 2.03) for 1 to 4.68 (3.39, 6.45) for 3/4 childhood harms. The PPV of ≥ 1 prospectively recorded harm did not differ between depressed (0.58 (0.52, 0.64)) and non-depressed (0.58 (0.55, 0.61)) groups.ConclusionsIn a population cohort, adult retrospective report of child abuse was associated with several harms, prospectively measured from childhood to adolescence, providing support for the validity of retrospective report-based research. Findings suggest retrospectively reported child abuse is not biased by depression in adulthood.
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Project description:The purpose of this study was to explore what adult survivors of child sexual abuse (CSA) believe will facilitate early disclosure of sexual abuse. We conducted semi-structured interviews with 12 adult survivors of CSA aged 18-57 years, and analyzed the transcripts using reflexive thematic analysis. Our analysis resulted in three main themes: Adults making it possible to tell; Adults daring to consider the unthinkable; and Conveying knowledge of CSA that facilitates understanding. The findings highlighted the importance of adults facilitating disclosure and making it possible for survivors to tell about their experiences, but also the responsibility adults have to dare to consider the possibility of CSA when children struggle. Another important finding was the significance of enhancing the general population's understanding of the complexity of CSA, including why disclosure is difficult, so adults are given the tools needed to understand and know what to do when they suspect CSA. The findings also have important implications for the planning and implementation of interventions to facilitate early disclosure of CSA.
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Project description:Background and objectiveChild abuse pediatricians (CAPs) are often asked to determine the likelihood that a particular child has been sexually abused. These determinations affect medical and legal interventions, and are important for multisite research. No widely accepted scale is available to communicate perceived sexual abuse likelihood. In this study, we measure intra- and inter-rater reliability of a 5-point scale to communicate child sexual abuse likelihood.MethodsWe developed a 5-point scale of perceived likelihood of child sexual abuse with example cases and medical-legal language for each risk category. We then surveyed CAPs who regularly perform sexual abuse evaluations using the abstracted facts of 15 actual cases with concern for sexual abuse. A subset of participants rated the same vignettes again, 1 month later.ResultsOf 512 invited participants, 240 (46.7%) responded, with 145 (28.3%) indicating that they regularly perform sexual abuse evaluations, 116 initially completing all 15 vignettes, and 36 completing repeat ratings at least 1 month later. The scale showed consistent stepwise increase in mean perceived likelihood of abuse and intention to report for each increase in scale rating. Inter-rater agreement was substantial (Fleiss' weighted kappa 0.64) and test-retest reliability among 36 participants was almost perfect (Cohen's kappa = 0.81).ConclusionsWe introduce a scale of perceived sexual abuse likelihood that appears to reflect CAPs' perceptions and intention to report. This scale may be a reasonable metric for use in multicenter studies. CAPs demonstrated substantial inter- and intrarater reliability when evaluating sexual abuse likelihood in case vignettes. While this scale may improve communication of sexual abuse likelihood among experts, its examples should not be used as a legal standard or a clinical criterion for sexual abuse diagnosis.
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Project description:The use of biomarkers in medicine is a common and valuable approach in several clinical fields. Understanding the relationship between measurable biological processes and clinical outcomes not only is indispensable in the face of understanding physiological processes in healthy as well as in diseased organisms but also for understanding and evaluating treatment effects. Therefore, also in the context of forensic psychiatry, biomarkers and their potentially beneficial effects are of growing interest. The objective of this review is to examine if there are biomarkers that may serve as a tool to support diagnostic process, treatment evaluation, and risk assessment of pedophilic individuals and child sexual offenders. In the first part, we present an overview of the current neurobiological, as well as physiological and psychophysiological approaches to characterize pedophilia and child sexual offending. Secondly, we discuss and evaluate the impact of these approaches on the development of biomarkers for diagnosis, therapy, and risk assessment in pedophilic subjects and child sexual offenders. We conclude that a lot of research has already enhanced our neurobiological knowledge about pedophilia and child sexual offending. Although there surely exist promising parameters and approaches, in our view currently none of these is ready yet to serve as a clinically applicable diagnostic, response, or predictive biomarker for pedophilia and child sexual offending. Therefore, further work remains to be done. The development of a composite diagnostic biomarker to assess deviant sexual interest, combining several measures like functional magnetic resonance imaging, electroencephalogram, eye tracking, and behavioral approaches seems to be most promising. A valid and reliable measurement of deviant sexual interest, insensitive to manipulations could significantly support clinical diagnostic process. Similarly, regarding therapy evaluation and risk assessment, a composite biomarker to assess inhibitory control functions seems to be promising. Furthermore, the application of the Research Domain Criteria-approach, a new approach for investigating and classifying mental disorders, offers the possibility to take research to a new level.
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Project description:Two studies investigated the role of group allegiances in contributing to the failure of institutions to appropriately respond to allegations of child sexual abuse. In Study 1, 601 participants read a news article detailing an allegation of child sexual abuse against a Catholic Priest. Catholics were more protective of the accused-and more skeptical of the accuser-than other participants, an effect that was particularly pronounced among strongly identified Catholics. In Study 2 (N = 404), the tendency for Catholics to be more protective of the accused and more skeptical of the accuser than non-Catholics was replicated. Moreover, these effects held independently of the objective likelihood that the accused was guilty. Overall, the data show that group loyalties provide a psychological motivation to disbelieve child abuse allegations. Furthermore, the people for whom this motivation is strongest are also the people who are most likely to be responsible for receiving and investigating allegations: highly identified ingroup members. The findings highlight the psychological mechanisms that may limit the ability of senior Church figures to conduct impartial investigations into allegations of child abuse within the Church.
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Project description:In Germany, access to outpatient treatment services devoted to the prevention of (further) sexual offenses against minors and child sexual exploitation material (CSEM) offenses is often limited. The therapy project "Prevention of Sexual Abuse" tries to fill this gap by providing treatment to patients with a self-reported sexual interest in children and adolescents, irrespective of whether or not they are pedophilic or prosecuted by the legal justice system. Within the project, a treatment manual was developed which specifically addresses dynamic risk-factors in child sexual abusers and CSEM offenders. The treatment manual was conceived to reduce recidivism risk and to contribute to the enhancement of the patients' personal well-being. In this paper, results of the accompanying scientific research are presented: offense-supportive attitudes (N = 23), self-reported CSEM use (N = 10), emotional distress (N = 24), and participants' subjective risk perception of committing (further) sexual offenses (N = 25) reduced during the course of treatment. A reduction of offense-supportive attitudes was further observed from pre-intervention to 1-year follow-up (N = 8). Changes with regard to self-efficacy, quality of life, participants' self-perceived ability to control sexual impulses toward children and adolescents permanently, and several measures assessing different kinds of sexual recidivism did not, however, reach any level of significance. During an average observation period of 2.4 years, six patients confessed to have conducted new sexual exploitation material offenses, while no further sexual abuse cases were reported (N = 19). Due to the used research design and small sample sizes, treatment effects cannot be inferred and external validity is limited. This notwithstanding, results provide first evidence for a relationship between treatment participation and self-reported recidivism and psychological well-being.
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