Association between Childhood Sexual Abuse History and Adverse Psychosocial Outcomes In controlled studies

• Controlled studies using nonclinical samples
• Meta-analyses that have examined the relationship between CSA and psychological adjustment

Nonclinical studies that have examined the relationship between child sexual abuse and psychological harm, after controlling for Social Environment

Study	Method	Results
Boney-McCoy & Finkelhor (1995)	Random: Nationally representative probability sample of 2,000 youths aged 10-16 years	After controlling for family dysfunction, significant associations were found between CSA and increased levels of PTSD symptoms and school difficulties. Abused boys reported significantly more sadness then other children.
Boney-McCoy & Finkelhor (1996)	Longitudinal: Reinterviewed 1995 sample 15 months later	Sexual abuse that occurred during the 15-month interim was associated with PTSD-related symptoms and depression not present prior to the assault.
Briere & Elliott (2003)	Random: Geographically stratified, general population sample of 1,442 adults	CSA was associated with a wide variety of psychological symptoms even after controlling for relevant background variables.
Brown et al. (1999)	Prospective: A cohort of 776 randomly selected children followed for 17 years	Compared with physical abuse and neglect, CSA was found to carry the greatest risk of depression and suicide, independently of environment and parent and child characteristics.
Dinwiddie et al. (2000)	Co-twin: Examined twins discordant for CSA drawn from cohort of 5,995 Australians twins. Included both males and females	The twin reporting CSA consistently displayed more psychopathology then their nonabused co-twin. However, only a single outcome reached statistical significance - the association between CSA and suicidal ideation in males.
Fergusson et al.  (1996)	Prospective: Followed a birth cohort of 1,019 male and female youths until adulthood	After controlling for family dysfunction, significant associations were found between CSA and higher rates of major depression, anxiety disorder, conduct disorder, substance use disorder, and suicidal behavior. Those whose abuse involved intercourse had the highest risk of disorder.
Fleming et al. (1999)	Random: Studied subsample of 710 women selected from a larger study involving women randomly selected from electoral rolls in Australia	After controlling for family dysfunction, significant associations were found between CSA and higher reports of domestic violence, rape, sexual problems, mental health problems, low self-esteem, and problems with intimate relationships. CSA involving intercourse was associated with the highest risk of disorder.
Johnson et al. (1999)	Prospective: Representative community sample of 639 youths	After controlling for family dysfunction, significant associations were found between CSA and increased rates of personality disorders during early adulthood.
Kendler et al. (2000)	Co-twin: Twins discordant for CSA drawn from a sample of 1,411 adult female twins	The twin reporting CSA was consistently at higher risk for lifetime psychiatric and substance use disorders compared to their nonabused co-twin with odds ratios generally increasing with the severity of the abuse.
Levitan et al. (2003)	Community sample of 6,597 individuals 15-64 years of age in Ontario , Canada	Examined the strength of the associations between early physical abuse, sexual abuse, and/or parental strain with depression alone, anxiety alone, and co-morbid depression/anxiety. A robust finding, consistent across all analyses, was a marked association between early sexual abuse and co-morbid depression and anxiety but not the 'pure' disorders.
Molnar, Berkman et al. (2001)	Nationally representative sample of 5,877 Americans aged 15 to 54 years	Among those sexually abused as children, odds of suicide attempts were 2-4 times higher among women and 4-11 times higher among men, compared with those not abused, after controlling for other adversities.
Molnar, Buka et al. (2001)	Nationally representative sample of 5,877 Americans aged 15 to 54	After numerous potential confounders were controlled for, a strong, independent statistically signficant relationship between childhood sexual abuse and the majority of mood, anxiety and substance abuse disorders. CSA victims were twice as likely as nonabused controls to suffer one or more mental disorders.
Mullen et al. (1993)	Random: Stratified, random community sample of 1,376 adult women in New Zealand	After controlling for family dysfunction, significant associations were found between CSA and higher levels of psychopathology, along with higher rates of substance abuse and suicidal behavior. A dose-response relationship was found with those suffering the most severe forms of abuse having the greatest level of psychopathology.
Nelson et al. (2002)	Co-twin: Examined 1991 same-sex pairs of twins (1159 female and 832 male pairs)	The twin reporting CSA had significantly greater risk for all 8 examined adverse outcomes (major depression, suicide attempt, conduct disorder, alcohol dependence, nicotine dependence, social anxiety, rape after the age of 18 years, and divorce) than their nonabused co-twins. The greatest risks were associated with CSA involving intercourse.
Stein et al. (1988)	Random: Community sample of 3,132 male and female adults.	After controlling for family dysfunction, significant associations were found between CSA and meeting diagnostic criteria for at least one lifetime psychiatric disorder, especially substance abuse disorders, major depression, phobia, panic disorder, and antisocial personality.

Meta-analyses that have examined the relationship between CSA and psychological adjustment.

Jumper, S. A. (1995). A meta-analysis of the relationship of child sexual abuse to adult psychological adjustment. Child Abuse & Neglect, 19, 715-728.

 Abstract: This paper reports on meta-analyses of the relations of child sexual abuse to  adult psychological adjustment. Results indicated statistically significant  relationships between the experience of child sexual abuse and subsequent difficulties in psychological adjustment as measured by psychological  symptomatology, depression, and self-esteem. Significant heterogeneity occurred across studies using a variety of different subject populations, research designs, and assessment methods. Some explanation of the effect size variance  was partially accounted for by certain identified study characteristics, most notable in regard to sample source used in the included studies. Student samples consistently generated smaller, more homogeneous effect size estimates than did community or clinical samples. This indicates that abused subjects drawn from student samples may experience fewer impairments in psychological adjustment, when compared to abused subjects drawn from community or clinical samples. The implications of these findings and suggestions for future research are discussed.

Neuman, D. A., Houskamp, B. M., Pollock, V. E., & Briere, J. (1996). The long-term sequelae of childhood sexual abuse in women: A meta-analytic review. Child Maltreatment, 1, 6-16.

Abstract:  The authors conducted a met-analytic review of the relationship between a history of child sexual abuse (CSA) and psychological problems in adult women in 38 studies meeting rigorous research criteria. Across all symptoms, a significant association was found between history of CSA and adult symptomatology. Analysis of the role of moderating variables indicated the associations were stronger among subjects recruited from clinical populations. When individual symptoms domains were examined, anxiety, anger, depression, revictimization, self-mutiliation, sexual problems, substance abuse, suicidality, impairment of self-concept, interpersonal problems, obsessions and compulsions, dissociation, post-traumatic stress responses, and somatization all yielded significant associations with sexual abuse. These results are discussed in light of their relevance to research methodolgy and clinical intervention.

Paolucci, E. O, Genuis, M. L., & Violato C. (2001). A meta-analysis of the published research on the effects of child sexual abuse. Journal of Psychology, 135 (1), 17-36.

Abstract: A meta-analysis of the published research on the effects of child sexual abuse (CSA) was undertaken for 6 outcomes: posttraumatic stress disorder (PTSD), depression, suicide, sexual promiscuity, victim-perpetrator cycle, and poor  academic performance. Thirty-seven studies published between 1981 and 1995  involving 25,367 people were included. Many of the studies were published in  1994 (24; 65%), and most were done in the United States (22; 59%). All six  dependent variables were coded, and effect sizes (d) were computed for each  outcome. Average unweighted and weighted ds for each of the respective outcome variables were .50 and .40 for PTSD, .63 and .44 for depression, .64 and .44 for  suicide, .59 and .29 for sexual promiscuity, .41 and .16 for victim-perpetrator cycle, and .24 and .19 for academic performance. A file drawer analysis  indicated that 277 studies with null ds would be required to negate the present findings. The analyses provide clear evidence confirming the link between CSA  and subsequent negative short- and long-term effects on development. There were no statistically significant differences on ds when various potentially mediating variables such as gender, socioeconomic status, type of abuse, age when abused, relationship to perpetrator, and number of abuse incidents were assessed. The results of the present meta-analysis support the multifaceted model of traumatization rather than a specific sexual abuse syndrome of CSA.

See also: Research Examining the Effects of Child Sexual Abuse on Men

References

Boney-McCoy, S., & Finkelhor, D. (1995). Psychosocial sequelae of violent victimization in a national youth sample. Journal of Consulting and Clinical Psychology, 63 , 726-736.

Boney-McCoy, S., & Finkelhor, D. (1996). Is youth victimization related to trauma symptoms and depression after controlling for prior symptoms and family relationships? A longitudinal, prospective study. Journal of Consulting and Clinical Psychology, 64 , 1406-1416.

Briere, J., & Elliott, D. M.  (2003). Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women. Child Abuse & Neglect, 27 , 1205-22

Brown, J., Cohen, P., Johnson, J. G., & Smailes, E. M. (1999). Childhood abuse and neglect: Specificity of effects on adolescent and young adult depression and suicidality. Journal of the American Academy of Child and Adolescent Psychiatry, 38 (12), 1490-6.

Dinwiddie, S., Heath, A. C., Dunne, M. P., Bucholz, K. K., Madden, P. A., Slutske, W. S., Bierut, L. J., Statham, D. B., & Martin, N. G. (2000). Early sexual abuse and lifetime psychopathology: A co-twin-control study. Psychological Medicine, 30 , 41-52.

Fergusson, D. M., Horwood, L. J., & Lynskey, M. T. (1996). Childhood sexual abuse and psychiatric disorder in young adulthood: II. Psychiatric outcomes of childhood sexual abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 34 , 1365-1374.

Fleming, J., Mullen, P. E., Sibthorpe, B., & Bammer, G. (1999). The long-term impact of childhood sexual abuse in Australian women. Child Abuse and Neglect, 23 , 145-159.

Johnson, J. G., Cohen, P., Brown, J., Smailes, E. M., & Bernstein, D. P. (1999). Childhood maltreatment increases risk for personality disorders during early adulthood. Archives of General Psychiatry, 56 , 600-606.

Jumper, S. A. (1995). A meta-analysis of the relationship of child sexual abuse to adult psychological adjustment. Child Abuse & Neglect, 19 , 715-728.

Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000). Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and cotwin control analysis. Archives of General Psychiatry, 57 , 953-959.

Levitan, R. D., N. A. Rector, Sheldon, T., & Goering, P. (2003). Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario : Issues of co-morbidity and specificity. Depression & Anxiety, 17, 34-42.

Molnar, B. E., Berkman, L. F., & Buka, S. L. (2001). Psychopathology, childhood sexual abuse and other childhood adversities: relative links to subsequent suicidal behaviour in the US . Psychological Medicine, 31 , 965-77.

Molnar, B. E., Buka, S. L., & Kessler, R. C. (2001). Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American Journal of Public Health, 9 1, 753-60.

Mullen, P. E., Martin, J. L., Anderson, J. C., Romans, S. E., & Herbison, G. P. (1993). Childhood sexual abuse and mental health in adult life. British Journal of Psychiatry, 163 , 721-732.

Nelson, E. C., Heath, A. C., Madden, P. A., Cooper, M. L., Dinwiddie, S. H., Bucholz, K. K., Glowinski, A., McLaughlin, T., Dunne, M. P., Statham, D. J., & Martin, N. G. (2002). Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: Results from a twin study. Archives of General Psychiatry, 59 (2), 139-45.

Neuman, D. A., Houskamp, B. M., Pollock, V. E., & Briere, J. (1996). The long-term sequelae of childhood sexual abuse in women: A meta-analytic review. Child Maltreatment, 1, 6-16.

Paolucci, E. O, Genuis, M. L., & Violato C. (2001). A meta-analysis of the published research on the effects of child sexual abuse. Journal of Psychology, 135 (1), 17-36.

Stein, J. A., Golding, J. N., Siegel, J. M., Burnam, M. A., & Sorenson, S .B. (1988). Long-term psychological sequelae of child sexual abuse. In G. E. Wyatt & G. J. Powell (Eds.), Lasting effects of child sexual abuse (pp. 135-154). Newbury Park , CA : Sage Publications.