A Longitudinal Study of Suicidal Ideation in Sexually Abused Adolescent Girls: Depressive Symptoms and Affect Dysregulation as Predictors.

Child sexual abuse (CSA) is associated with many repercussions on adolescents' mental health, including suicidal ideation. Yet, the mechanisms linking CSA to adverse outcomes have rarely been investigated within a longitudinal design. The current study aimed to examine the role of affect dysregulation in the association between depressive symptoms and suicidal ideation 1year after the first assessment in a sample of 119 sexually abused adolescent girls. An integrative mediational model was conceptualized to examine the explicatory role of affect dysregulation (Time 2) in the association between depressive symptoms (Time 1) and suicidal ideation (Time 3). Approximately 31% of the girls reported suicidal ideation at Time 3. Path analysis with logistic regressions revealed that the association between depressive symptoms and suicidal ideation presence was partly explained by affect dysregulation, which increased the risk of suicidal ideation presence by 18.4%, OR = 1.18, 95% CI [1.07, 1.33]. The integrative model explained 21.5% of the variance in suicidal ideation. These findings identify potential predictors of suicidal ideation among sexually abused adolescent girls. This present study highlights the role of affect dysregulation in the presence of suicidal ideation and provides potential targets for intervention practices when working with adolescent girl victims of CSA. As such, interventions for this vulnerable population should aim to decrease depressive symptoms and affect dysregulation to reduce suicidal risk.

Self-Blame, Shame, Avoidance, and Suicidal Ideation in Sexually Abused Adolescent Girls: A Longitudinal Study.

Depressive symptoms, posttraumatic stress disorder, and suicidal ideation are among the most prevalent problems associated with sexual abuse. Based on the Traumagenic dynamic of stigmatization model, the aim of this study was to investigate whether self-blame, shame, and maladaptive coping strategies predicted posttraumatic stress disorder, depressive symptoms, and suicidal ideation among sexually abused adolescent girls using a longitudinal design. A total of 100 adolescent girls completed a series of questionnaires at the initial visit at the intervention center (T1) and 6 months later (T2). Path analysis reveals shame at T1 predicted posttraumatic stress disorder symptoms at T2 whereas self-blame at T1 predicted depressive symptoms at T2. Furthermore, avoidance coping at T1 and depressive symptoms at T2 predicted suicidal ideation at T2 and accounted for 54% of the variance. These findings suggest that interventions designed for sexually abused adolescent girls should target shame, self-blame, and avoidance coping to foster recovery in this vulnerable population.

Maternal Emotional Support following the Disclosure of Child Sexual Abuse: A Qualitative Study.

Non-offending maternal (NOM) support is considered one of the most important protective factors in facilitating better victim adjustment following the disclosure of child sexual abuse (CSA). However, recent findings have led authors to conclude that NOM support has yet to be properly conceptualized and operationalized within the CSA literature. Emotional support is one dimension that has consistently emerged in studies attempting to reconceptualize NOM support but is a concept which also requires further theoretical investigation. Researchers interviewed 22 mothers of children aged 6-12 years about their experience and provision of emotional support following their child's disclosure of CSA. Data were analyzed using a method inspired by grounded theory. Mothers reported feeling initially overwhelmed and lost about how to emotionally support their child but described an improvement in their support capabilities following conjoint therapy. Furthermore, three overarching categories emerged outlining maternal emotional support strategies, each serving a specific emotional function: (a) elaborating, encouraged children to talk about their CSA experience; (b) soothing, attempted to comfort children's distress; and (c) orienting, attempted to guide children's recovery process. Authors discuss implications for offering improved and more rapid clinical services following the disclosure of CSA, and considerations for the operationalization of NOM emotional support.

Posttraumatic Stress Disorder and Suicidal Ideation Among Sexually Abused Adolescent Girls: The Mediating Role of Shame.

Sexual abuse is associated with a host of negative repercussions in adolescence. Yet the possible mechanisms linking sexual abuse and negative outcomes are understudied. The purpose of this study was to investigate the relationships among self-blame, shame, coping strategies, posttraumatic stress disorder, depressive symptoms, and suicidal ideation. The sample included 147 sexually abused adolescent girls between 14 and 18 years of age. A total of 66% of girls reached clinical score for posttraumatic stress disorder, and 53% reached clinical score for depressive symptoms. Close to half (46%) reported suicidal thoughts in the past 3 months. Shame was found to partially mediate the relationship between self-blame and posttraumatic stress disorder. Shame and depressive symptoms were also found to partially mediate the relationship between self-blame and suicidal ideation. Results suggest that shame is a crucial target in interventions designed for sexually abused adolescent girls.

Psychological and Physical Health of Nonoffending Parents After Disclosure of Sexual Abuse of Their Child.

Disclosure of child sexual abuse can be traumatic for nonoffending parents. Research has shown its impact on mothers' mental health, which includes heightened psychological distress, depression, and post-traumatic stress disorder. Very little is known, however, about its impact on their physical health or on fathers' health. The self-perceived mental and physical health of nonoffending parents after child sexual abuse disclosure was compared to determine gender-related differences in this regard. Interviews were conducted with 109 mothers and 43 fathers of 6- to 13-year-old sexually abused children. Bivariate analyses revealed that a fair proportion of parents reported psychological and physical problems after disclosure. However, proportionally more mothers than fathers reported psychological distress, depression, and use of professional services. Fathers were more likely to resort to health services instead of social services and to use medication for depression. Study findings provide leads for health and social service providers for the development of intervention protocols and referral procedures sensitive to gender issues, and they shed new light on specific needs of nonoffending parents.

Factors associated with delayed disclosure of child sexual abuse: A focus on the victim's having been led to perform sexual acts on the perpetrator.

BACKGROUND: Contextual variables associated with children's willingness to disclose sexual abuse have been identified in previous studies, but further investigation is needed to better understand delayed disclosure of child sexual abuse (CSA). OBJECTIVES: This study aimed to examine the factors associated with the risk of delayed disclosure of CSA. More specifically, it focused on a factor that has rarely, if ever, been looked into: the fact that some victims are led to perform sexual acts on the perpetrator. PARTICIPANTS AND SETTING: A content analysis was performed on 68 transcripts of investigative interviews with CSA victims aged 4 to 12 years old. METHODS: Based on our content analysis, the time between the first abuse and the first disclosure was determined for each victim. The age and gender of the victim, the victim's relationship with the perpetrator, the age of the perpetrator, the frequency and severity of the abuse, and whether or not the victim mentioned having performed sexual acts on the perpetrator were also coded. RESULTS: Chi-square analyses showed that the risk of delayed disclosure was associated with the victim's having performed, or not performed, sexual acts on the perpetrator (χ2 = 16.327, p < 0.001), the victim's relationship with the perpetrator (χ2 = 10.013, p = 0.002), and the frequency of the abuse (χ2 = 11.617, p < 0.001). CONCLUSION: Our study is the first to demonstrate that having been led to sexually touch the perpetrator is associated with delayed disclosure of CSA.

Support and profiles of nonoffending mothers of sexually abused children.

Maternal support offered to sexually abused children following disclosure may be a crucial factor in children's recovery. A person-centered approach was used to examine how profiles of nonoffending mothers could better describe their ability to support their children after disclosure. Cluster analyses based on a total of 226 nonoffending mothers recruited from child protective services yielded four distinctive groups of mothers: resilient, avoidant-coping, traumatized, and anger-oriented reaction. These profiles differed on measures of support, parenting, and variables related to attitude following disclosure. The discussion underscores the relevance of adopting a tailored approach to intervention with mothers of sexually abused children.

Correlates and Predictors of Mothers' Adaptation and Trauma Symptoms Following the Unveiling of the Sexual Abuse of Their Child.

Child sexual abuse (CSA) can severely affect the mental health of children and their parents. While correlates of recovery have been documented in children, factors exacerbating parents' adaptation to their child's unveiling of CSA deserves further attention. Parents' history of abuse has been inconsistently identified as a predictor of their distress in reaction to their child's abuse disclosure. This study proposes a mediation model that explores various processes underlying mother's psychological distress (posttraumatic stress disorder [PTSD], dissociation, and their comorbidity) following their children's unveiling of CSA. It investigates the influence of mother's own CSA, as well as of her exposure to additional forms of past and current victimization, on her reaction to the child's CSA disclosure, while considering coping mechanisms as mediators (avoidance, problem solving, search for social support, and feeling of guilt). Data were collected through self-report measures completed by 298 mothers of children who had recently disclosed CSA. Path analyses revealed that mother's exposure to interparental violence as a child acted as a primary predictor of dissociation and of its comorbidity with PTSD, while a history of CSA was directly and exclusively linked to dissociation. Being exposed to recent partner violence was indirectly related to trauma symptoms, with coping mechanisms acting as mediators. This study outlines the relationship between mother's psychological distress and her cumulative, past, and current exposure to various forms of victimization. Exposure to interparental violence as a child represents a particularly important factor for identifying mothers most in need of support, as it is a significant predictor of dissociation and of its comorbidity with PTSD.

Prevalence of childhood sexual abuse and timing of disclosure in a representative sample of adults from Quebec.

OBJECTIVE: Our study sought to explore patterns of disclosure of child sexual abuse (CSA) in a sample of adult men and women. METHOD: A telephone survey conducted with a representative sample of adults (n = 804) from Quebec assessed the prevalence of CSA and disclosure patterns. Analyses were carried out to determine whether disclosure groups differed in terms of psychological distress and symptoms of posttraumatic stress, and a logistic regression was used to examine factors associated with prompt disclosure. RESULTS: Prevalence of CSA was 22.1% for women and 9.7% for men. About 1 survivor out of 5 had never disclosed the abuse, with men more likely not to have told anyone, than women. Only 21.2% of adults reported prompt disclosure (within a month of the first abusive event), while 57.5% delayed disclosure (more than 5 years after the first episode). CSA victims who never disclosed the abuse and those who delayed disclosure were more likely to obtain scores of psychological distress and posttraumatic stress achieving clinical levels, compared with adults without a history of CSA. In the multivariate analysis, experiencing CSA involving a perpetrator outside the immediate family and being female were factors independently associated with prompt disclosure. CONCLUSION: A significant number of adult women and men reported experiencing CSA, and most victims attested to either not disclosing or significantly delaying abuse disclosure.

Paternal support for child sexual abuse victims: A qualitative study.

BACKGROUND: The current state of knowledge regarding the role of non-offending fathers in supporting their sexually abused children is very scarce. OBJECTIVE: The objective of this study is to further our understanding of fathers' roles following disclosure of their children's sexual abuse (SA) by evaluating fathers' perceptions of the impact of disclosure on their involvement and support of their children. PARTICIPANTS AND METHOD: This qualitative study relies on individual semi-structured interviews conducted with 17 fathers of allegedly abused children. RESULTS: Inductive thematic analysis first highlighted that some reported a period of disengagement from the child during which they put into question their role and attitudes, followed by a period of re-involvement. This period of difficulties experienced by some fathers in regard to their involvement towards their children was due to either their own important psychological distress, their ambivalence towards their child or even because of feelings of uneasiness experienced during physical contact with them. Despite this, findings indicate the presence of thoughts and attitudes that suggest children are a source of concern for fathers. The four forms of abuse-specific support previously observed among mothers (believing the child, seeking out professional services, protecting him/her from the offender, supporting him/her emotionally) were also observed among fathers. In accordance with the activation theory, a form of support specific to fathers, namely, encouraging the child to open up to and explore the world outside the family, thereby, fostering the child's self-esteem development, was observed and constitutes a relevant finding. CONCLUSION: Clinical and empirical implications are discussed.

Prevalence and co-occurrence of violence against children in the Quebec population.

OBJECTIVE: A literature review on the incidence of different forms of child maltreatment revealed that rates in Australia and Quebec (Canada) were similar. This study sought to determine the prevalence and co-occurrence of various forms of violence (physical, sexual and psychological) and explore gender and age difference. METHODS: A telephone inquiry was conducted with a representative sample of 1,002 adults from the province of Quebec. RESULTS: More than one in three adults (37%) reported having experienced at least one of three forms of violence in childhood. Twelve per cent (12%) of the adults experienced two forms of violence while 4% of the respondents reported having experienced all three forms of violence in childhood. Psychological violence (22%) was the form most frequently reported, followed by physical violence (19%) and sexual violence (16%). The different prevalence rates did not vary as a function of age. However, regarding gender, women were more likely to report having been sexually victimised (rape and fondling) and less likely to report having experienced physical violence. A lower percentage of women reported having sustained no form of childhood victimisation and a higher percentage of women reported have experienced both sexual and psychological violence compared to men. CONCLUSION: These results, including both the global rates and those particular to each gender, are comparable to findings in similar North American studies. The co-occurrence rates noted are salient enough to necessitate particular attention to diverse clinical clientele and need to be considered in future research exploring the risk factors of violence and its subsequent repercussions.

An analysis of avoidant and approach coping as mediators of the relationship between paternal and maternal attachment security and outcomes in child victims of sexual abuse.

OBJECTIVE: Prior studies have documented the potential role of nonoffending parent support in promoting recovery of adult survivors following sexual abuse (SA). However, few studies have distinguished the maternal and paternal role and the mechanisms by which quality of the parent-child relationship might foster more positive outcomes in child victims. The purpose of this study was to examine coping strategies as mediators of the link between mother-child and father-child relationship and outcomes following child SA. METHOD: A sample of 505 children (339 girls and 166 boys) ages 6-13 years completed measures evaluating perceived attachment security to mother and father (Kerns Security Scale; Kerns, Klepac, & Cole, 1996), as well as coping strategies related to the SA experienced (Self-Reported Coping Scale; Causey & Dubow, 1992). Outcomes evaluated were posttraumatic stress symptoms (PSS; Children's Impact of Traumatic Events Scale-II [CITES-II]; Wolfe, 2002) and self-esteem (Harter, 1985). RESULTS: Results indicated that, in girls, both attachment security to the mother and to the father are associated with lower PSS symptoms and higher self-esteem through a lesser use of avoidant coping. Avoidance coping mediated the link between attachment security to the mother and outcomes in boys. In addition, security in the relationship with the same-sex parent was associated with approach coping, which in turn was associated with both outcomes for girls and with PSS for boys. CONCLUSION: Findings highlight the importance of involving both parents in interventions for sexually abused children as mothers and fathers appear to play different, yet complementary roles in sustaining children's recovery. (PsycINFO Database Record

Sexual abuse and preschoolers: Forensic details in regard of question types.

The present study looks into the association between the types of questions used by interviewers and the number of details obtained among preschoolers during an investigative interview. An innovative aspect of this study concerns the analysis of question subtypes (eg. open-ended directive and closed-ended). Analysis of variance were carried out on 55 NICHD interview protocols conducted among children aged three to five years old who disclosed an episode of sexual abuse. Findings reveal that interviewers' style is in accordance with best practices in conducting investigative interviews with children allegedly victims of sexual abuse. As expected, there are more details in answers: 1) provided by older children compared to younger counterparts; 2) following invitations compared to all other question types. However, the analysis of question subtypes has shown that answers given to an open-ended question using cues (cued invitations or directive open-ended) obtained more details concerning the incident compared to the absence of cues (general invitations). These findings support the fact that children as young as three years old are able to produce informative responses when questioned appropriately about the CSA incident and propose reconsidering the types of question that should mainly be used with them. Findings suggest that the use of open-ended questions, using a cue previously mentioned in the testimony of the child, helps provide a detailed account during an investigative interview conducted among preschoolers allegedly victims of sexual abuse.

[The influence of cognitive abilities, age and characteristics of their sexual abuse experience on the statement of the presumed victims]. / L'influence des habiletés cognitives, de l'âge et des caractéristiques de l'agression sexuelle sur la déclaration des présumées victimes.

OBJECTIVE: The goal of the present study was to examine the effects of children's age, cognitive abilities and the characteristics of their sexual abuse experience on the quantity of details revealed about the sexual abuse in an investigative interview as a function of the type of questions asked. METHOD VERSION: Transcripts of 37 investigative interviews conducted with children between 6 and 12 years of age were analyzed according to the type of interviewer questions used and the quantity of details given by the child. The children's cognitive abilities were measured using the vocabulary, information and block design subtests of the WISC-III. RESULTS: Results of multiple regression analyses indicate that children's age and verbal abilities as well as their relationship with the perpetrator explain 50% of the variance of the mean number of details obtained from the child following open-ended interviewer questions. CONCLUSION: The results of this study suggest that the quantity of details obtained during an investigative interview is influenced not only by children's age but also by their verbal skills and the child-perpetrator relationship.

Prevalence and predictors of dating violence among adolescent female victims of child sexual abuse.

The purpose of this study was to advance knowledge of dating violence behaviors among adolescent victims of child sexual abuse (CSA), first, by determining the prevalence of psychological and physical dating violence and the reciprocity of violence, and second, by investigating the influence of certain CSA characteristics to dating violence. Respondents included 126 females ages 13 to 17 years. More than 45% reported experiencing some sort of physical violence in their dating relationships. Psychological violence was reciprocal in more than 90% of the cases. Multiple regression analysis revealed a significant contribution of CSA characteristics. Multiple regression analyses revealed that the duration of the sexual abuse and the presence of violence or completed intercourse during the abuse could significantly contribute to dating violence above and beyond other known risk factors. Discussion underscores the need to gain a better understanding of CSA and other risk factors that might influence violent dating behaviors.

Impact of interviewers' supportive comments and children's reluctance to cooperate during sexual abuse disclosure.

In the field of child sexual abuse (CSA) disclosure, many studies have been conducted on the impact of interviewers' questioning style, but few have examined the impact of interviewers' supportive comments on children's cooperative and reluctant disclosure of substantive details. This field study used a sample of children ranging from 4 to 13 years of age who have all disclosed CSA. The first objective was to examine if the interviewer's and the child's comments during CSA interviews would vary as a function of the use of the National Institute of Child Health and Human Development (NICHD) Protocol. The second objective was to identify the strongest correlates of the proportion of details disclosed by the children during forensic interviews. A total of 90 matched NICHD Protocol and non-Protocol interviews done by the same interviewers were audio-taped, transcribed, and coded using verbal subscales. The goal was to explore if differences exist between the interviewers' supportive and non-supportive comments as well as children's cooperative and reluctant statements during investigative interviews conducted prior to or after the NICHD Protocol training. Results of a MANCOVA showed that the use of the NICHD Protocol had no influence on interviewers' and children's demeanors. A hierarchical multiple regression analysis controlling for relevant variables (e.g., child's age and NICHD Protocol) showed that children's reluctance and interviewers' non-support were associated with a lesser proportion of details. Overall, these results indicate that in order to promote detailed disclosure of CSA, interviewers should decrease their non-supportive comments and learn to deal more effectively with children's reluctance during forensic interviews. As such, protocols and training should encourage investigative interviewers to devote more time identifying early signs of children's verbal reluctance and to understand the negative impact of non-supportive comments on the disclosure of substantive details.

[Current understanding about intergenerational transmission of child sexual abuse]. / La transmission de la violence sexuelle: description du phénomène et pistes de compréhension.

OBJECTIVE: The aim of this article is to review what is currently understood about intergenerational transmission of child sexual abuse (CSA). METHOD: CSA transmission is discussed first from the point of view of men CSA survivors who become sexually abusive, and then from the perspective of mothers who survived CSA whose children have been sexually abused. Mechanisms that may help us understand how CSA is transmitted from one generation to another are described. More specifically, focus is given to those mechanisms that might differentiate CSA survivors who break the cycle of abuse from those who perpetuate it. RESULTS: In light of the research reviewed, it seems that the transmission of CSA is far from inevitable, since one-third of sexually abusive men and half of sexually abused children's mothers mentioned having been sexually abused in their childhood. Because of the retrospective method used in many studies, causal links could not be established. However, some mechanisms have been proposed in order to better understand the phenomenon of CSA. Severity of abuse, attachment relationships with parental figures, as well as dissociative symptoms that follow the abuse were identified. Dissociative symptomatology appeared to be a determining factor in understanding the cycle of CSA. CONCLUSIONS: More studies on CSA transmission are needed to understand the mechanisms that are involved in that cycle, as well as to develop effective strategies to treat and prevent CSA.

[Contextual factors associated with the symptoms of teenagers victims of intrafamilial sexual aggression]. / Facteurs contextuels associés aux symptômes d'adolescentes victimes d'agression sexuelle intrafamiliale.

OBJECTIVE: The aim of the study was to identify the unique contribution of three sets of contextual factors (maternal supports, family problems and characteristics of the sexual aggression) on adolescents' post-disclosure symptoms. All participants were abused by a family member. METHOD: A total of 71 adolescents girls were recruited from youth center services across Quebec. Psychological distress was evaluated with "Trauma Symptoms Checklist for Children" (TSC-C; Briere, 1989). Adolescents also completed self-report instruments and semi-structured interviews to evaluate contextual factors. RESULTS: Regression analyses indicated that general maternal support explain more variance in most of TSC-C symptoms than maternal response to disclosure. Analysis highlight that alcohol problems in family and various characteristics of sexual aggression explain a unique part of variance of several symptoms. CONCLUSIONS: The discussion addresses the need to continue to explore these questions with more specific instruments to evaluate family problems. A large spectrum of symptoms should also be considered.

Intrafamilial sexual abuse: brother-sister incest does not differ from father-daughter and stepfather-stepdaughter incest.

OBJECTIVE: Three groups of girls who were sexually abused (by either brothers, fathers, or stepfathers) were compared. The purpose was to identify the differing characteristics of the abuse, the family environments, and the psychosocial distress of these children. METHOD: Seventy-two girls aged between 5 and 16 were assigned to one of the three groups. Subjects were matched between groups on the basis of their actual age. Children completed measures of traumatic stress; their mothers completed the Child Behavior Checklist-Parent Report Form (CBCL) and other self-report questionnaires on family characteristics. Workers in child protective services completed information regarding the nature and severity of the abuse. RESULTS: Results suggested few differences in the characteristics of sexual abuse between the three groups. However, penetration was much more frequent in the sibling incest group (70.8%) than in the stepfather incest (27.3%) or father incest (34.8%) groups. Ninety percent of the victims of fathers and brothers manifested clinically-significant distress on at least one measure, whereas 63.6% of stepfather victims did. Compared with father and stepfather perpetrators, brothers were raised in families with more children and more alcohol abuse. CONCLUSIONS: The authors conclude that the characteristics of brother-sister incest and its associated psychosocial distress did not differ from the characteristics of father-daughter incest These findings suggest that theoretical models and clinical practices should be adjusted accordingly and that sibling incest should not necessarily be construed as less severe or harmful than father-daughter incest.

Self-destructive and delinquent behaviors of adolescent female victims of child sexual abuse: rates and covariates in clinical and nonclinical samples.

Self-destructive and delinquent behaviors were assessed in three samples of adolescent females. The first sample (N=140) were substantiated victims of sexual abuse recruited from clinical settings. They were contrasted to a second sample (N=430) of secondary school students, and a third sample from the same school setting (N=94), that reported that they had been sexually abused. Few differences were found between the two groups of sexually abused girls, and both groups reported significantly more at-risk behaviors than nonabused girls. Family adversity was a consistent predictor of both self-destructive and delinquent behaviors. However, violence during the abuse, lower quality mother-daughter relationships, and depression were also related to self-destructive behaviors, while family economic problems and self-blame for the abuse were the only correlates of delinquent behavior.