Medium-term health and social outcomes in adolescents following sexual assault: a prospective mixed-methods cohort study.

PURPOSE: To describe medium-term physical and mental health and social outcomes following adolescent sexual assault, and examine users' perceived needs and experiences. METHOD: Longitudinal, mixed methods cohort study of adolescents aged 13-17 years recruited within 6 weeks of sexual assault (study entry) and followed to study end, 13-15 months post-assault. RESULTS: 75/141 participants were followed to study end (53% retention; 71 females) and 19 completed an in-depth qualitative interview. Despite many participants accessing support services, 54%, 59% and 72% remained at risk for depressive, anxiety and post-traumatic stress disorders 13-15 months post-assault. Physical symptoms were reported more frequently. Persistent (> 30 days) absence from school doubled between study entry and end, from 22 to 47%. Enduring mental ill-health and disengagement from education/employment were associated with psychosocial risk factors rather than assault characteristics. Qualitative data suggested inter-relationships between mental ill-health, physical health problems and disengagement from school, and poor understanding from schools regarding how to support young people post-assault. Baseline levels of smoking, alcohol and ever drug use were high and increased during the study period (only significantly for alcohol use). CONCLUSION: Adolescents presenting after sexual assault have high levels of vulnerability over a year post-assault. Many remain at risk for mental health disorders, highlighting the need for specialist intervention and ongoing support. A key concern for young people is disruption to their education. Multi-faceted support is needed to prevent social exclusion and further widening of health inequalities in this population, and to support young people in their immediate and long-term recovery.

Key socio-demographic characteristics of children and adolescents with gender dysphoria: A British Isles surveillance study.

The present research used linked surveillance systems (British Paediatric Surveillance Unit; and the Child and Adolescent Psychiatry Surveillance System) over a 19 month period (1 November 2011-31 May 2013) to notify of young people (4-15.9 years) presenting to secondary care (paediatrics or child and adolescent mental health services) or specialist gender services with features of gender dysphoria (GD). A questionnaire about socio-demographic, mental health, and GD features was completed. Presence of GD was then assessed by experts in the field using then-current criteria (DSM-IV-TR). Incidence across the British Isles was 0.41-12.23 per 100,000. 230 confirmed cases of GD were noted; the majority were white (94%), aged ≥12 years (75.3%), and were assigned female at birth (57.8%). Assigned males presented most commonly in pre-adolescence (63.2%), and assigned females in adolescence (64.7%). Median age-of-onset of experiencing GD was 9.5 years (IQR 5-12); the majority reported long-standing features (2-5 years in 36.1%, ≥5 years in 26.5%). Only 82.5% attended mainstream school. Bullying was reported in 47.4%, previous self-harm in 35.2%, neurodiversity in 16%, and 51.5% had ≥1 mental health condition. These findings suggest GD is rare within this age group but that monitoring wellbeing and ensuring support for co-occurring difficulties is vital.

Somatic symptoms following sexual assault in adolescents: a prospective longitudinal study.

Adults and young people with somatoform disorders and somatic symptoms retrospectively report high rates of sexual abuse. We aimed to assess somatic symptoms in young people in the aftermath of a sexual assault and to document links with assault characteristics, with psychopathology and with related functional impairment. This was a prospective cohort study of adolescents seen in specialized clinics in London in the first 6 weeks following a sexual assault and at 4-5 months follow-up. We enquired about somatic symptoms (headaches, abdominal pain and sickness) pre and post assault, and we assessed psychiatric disorders and functional impairment at follow-up using validated scales. Information was obtained on 94 females (mean age 15.6, SD 1.3). There was a statistically significant increase in the number of adolescents reporting somatic symptoms at 4-5-month follow-up (65/94, 69%) (p = 0.035), compared with estimated pre-assault rates (52/94, 55%) and a significant increase in somatic symptoms at follow-up among the victims of violent sexual abuse (p < .001). Subjects with somatic symptoms at follow-up had significant higher rates of psychiatric disorders - especially generalised anxiety disorder, panic disorder and major depressive disorders - as well as lower psychosocial functioning (p < 0.01), than those without somatic symptoms.

Correlates and predictors of self-harm in a prospective sample of sexually assaulted adolescents.

BACKGROUND: Sexual assault of adolescents is associated with negative mental health outcomes, including self-harm. Little is known about correlates and predictors of self-harm after sexual assault. We hypothesized that pre-assault vulnerabilities and post-assault psychological distress would be associated with self-harm after experiencing a recent sexual assault. METHODS: The sample was recruited from adolescents aged 13 to 17 years accessing sexual assault centers and it included 98 females. Longitudinal data were collected at T0 (3.9 weeks on average post-assault) and T1 (21.8 weeks on average post-assault). Bivariate analysis and hierarchical binary logistic regressions were performed. RESULTS: The rate of self-harm was 38.1% before the assault and 37.8% after the assault (T1). History of family dysfunction (OR 3.60 (1.30, 10.01)), depressive symptoms at T0 (OR 5.83 (2.35, 14.43)) or T1 (OR 2.79 (1.20, 6.50), and posttraumatic stress symptoms at T1 (OR 3.21 (1.36, 7.58)) predicted self-harm at T1. These effects were attenuated when adjusting for confounders, except for depressive symptoms at T0 (OR 4.21 (1.57, 11.28)). DISCUSSION: Clinical implications for the prevention of onset or continuation of self-harm following adolescent sexual assault are discussed. Future studies should replicate these findings in a larger sample and consider different trajectories of self-harm.

Complex post-traumatic stress symptoms in female adolescents: the role of emotion dysregulation in impairment and trauma exposure after an acute sexual assault.

Background: Adolescents are at high risk of sexual assault compared to any other age group. The pattern of post-traumatic stress symptoms plus life-impairing disturbances in self-organization (emotion dysregulation, negative self-concept and interpersonal problems) is termed Complex Post-Traumatic Stress Disorder (CPTSD). Research about CPTSD after sexual assault in adolescents is limited owing to the challenges associated with assessing this group. This study aims to determine the frequency and structure of CPTSD, and the relationship of emotion dysregulation with impairment and additional trauma exposure among adolescents who have been sexually assaulted. Method: Prospective cohort study of adolescents attending the Sexual Assault Referral Centres serving London over a 2-year period. We conducted cross-sectional analyses (n = 99) on data collected 4-5 months after sexual assault, and Confirmatory Factor Analyses (CFA) and Latent Class Analyses (LCA) to determine the CPTSD profile. CTPSD was defined according to the ICD-11, selecting symptom indicators from the following measures: Strengths and Difficulties Questionnaire (SDQ), Children's Revised Impact of Event Scale (CRIES-13), Short version of the Mood and Feelings Questionnaire (S-MFQ), The Development and Well-Being Assessment (DAWBA). We analysed the association of CPTSD symptom domains with impairment (measured with the SDQ, and the Children's Global Assessment Scale; C-GAS) and with additional trauma exposure. Results: The frequency of ICD-11 PTSD was 59%, and of ICD-11 CPTSD was 40%. CPTSD symptoms showed a strong fit for a correlated 4-factor model, and LCA distinguished a class of participants with high levels of CPTSD symptoms. Emotion dysregulation was associated with impairment in functioning and exposure to trauma beyond other self-organization disturbances and core PTSD symptoms. Conclusions: Disturbances in self-organization are frequent in sexually assaulted adolescents, and emotion dysregulation is associated with impairment and further exposure to trauma. Emotion dysregulation should be considered in preventive and treatment strategies for these vulnerable youth.

Antecedentes: Las adolescentes presentan mayor riesgo de abuso sexual comparadas con cualquier otro grupo de edad. El patrón de síntomas de estrés postraumáticos sumados a las perturbaciones incapacitantes en la autoorganización (desregulación emocional, autoconcepto negativo, y problemas interpersonales) recibe el nombre de trastorno de estrés postraumático complejo (TEPT-C). Las investigaciones en TEPT-C luego de un abuso sexual en adolescentes es limitado dados los desafíos asociados a la evaluación de este grupo. El presente estudio busca determinar la frecuencia y estructura del TEPT-C, y la relación entre la desregulación emocional con deterioro y con exposición a traumas adicionales en mujeres adolescentes en quienes se haya cometido abuso sexual.Métodos: Se realizó un estudio prospectivo de cohortes en adolescentes que acudían a los Centros de Referencia por Abuso Sexual que operan en Londres, durante un periodo de dos años. Condujimos análisis transversales (n = 99) en la información recolectada cuatro a cinco meses después del abuso sexual, además de Análisis Factoriales de Confirmación (AFC) y Análisis de Clases Latentes (ACL) para determinar el perfil del TEPT-C. Se definió al TEPT-C según la CIE-11, seleccionando indicadores de los síntomas a partir de las mediciones siguientes: Cuestionario de Fortalezas y Debilidades (SDQ, por sus siglas en inglés), Escala de Impacto del Evento Revisado para Niños (CRIES-13, por sus siglas en inglés), la Versión Abreviada del Cuestionario de Ánimo y Emociones (S-MFQ, por sus siglas en inglés), la Evaluación del Desarrollo y Bienestar (DAWBA, por sus siglas en inglés). Analizamos la asociación de los dominios de síntomas del TEPT-C con deterioro (medido en la SDQ, y con la Escala de Evaluación Global Infantil; C-GAS, por sus siglas en inglés), y con exposición a traumas adicionales.Resultados: La frecuencia del Trastorno de Estrés Postraumático (TEPT) según la CIE-11 fue de 59%, y de TEPT-C según la CIE-11 fue de 40%. Los síntomas de TEPT-C mostraron un ajuste alto con un modelo correlacionado de cuatro factores, y el ACL distinguió una clase de participantes con alto niveles de síntomas del TEPT-C. El deterioro en el funcionamiento y la exposición a traumas posteriores asociados con la desregulación emocional fueron más allá de las perturbaciones en la autorregulación y en los síntomas nucleares del TEPT.Conclusiones: Las perturbaciones en la autoorganización son frecuentes en adolescentes en quienes se ha cometido un abuso sexual, y la desregulación emocional está asociada con deterioro y con exposición posterior a trauma. La desregulación emocional debería ser considerada en estrategias de prevención y tratamiento para estas jóvenes vulnerables.

A systematic review of short and medium-term mental health outcomes in young people following sexual assault.

Objective: Sexual assault peaks in adolescence, yet sequelae at this age are not well understood. This systematic review aimed to describe mental health outcomes following sexual assault in young people. Method: Two reviewers independently searched databases, screening publications from 1990 to 2018. Inclusion criteria included: longitudinal studies, systematic reviews, and meta-analyses with ≥50% participants aged ten to 24 years; baseline mental health assessment prior to/or <8 weeks post-assault with follow-up ≥ 3 months after the initial assessment.Results: 5 124 titles and abstracts were screened, with 583 papers examined in full. Ten studies met inclusion criteria (sample size 31 to 191). Five studies examined rates of post-traumatic stress disorder (PTSD), reporting rates of up to 95% within one month and up to 60% at 12 months post-assault. Studies evaluating post-traumatic (n = 5) and anxiety (n = 3) symptom scores showed symptoms were highest in the immediate aftermath of the trauma, generally reducing over four to 12 months post-assault. Depressive symptomology appeared to vary between studies (n = 5). However, the majority showed symptoms decreasing over the same time period.Conclusions: Psychopathology is common following sexual assault in young people. Most studies observed reduced rates over time, but there is a paucity of longitudinal research. Psychopathology during the first year after sexual assault is an important treatment target to consider.

Mental and sexual health outcomes following sexual assault in adolescents: a prospective cohort study.

BACKGROUND: Young people are disproportionately affected by sexual assault, yet longitudinal data are sparse. This paper examines the characteristics of adolescents presenting to sexual assault services and mental and sexual health outcomes after an assault. METHODS: This was a prospective cohort study in adolescents aged 13-17 years attending the Sexual Assault Referral Centres serving Greater London, UK, over 2 years. Baseline interviews (T0) were done less than 6 weeks after an assault to collect data on sociodemographic and assault characteristics and psychological symptoms, with follow-up interviews (T1) at 4-5 months after the assault. Four psychological symptom questionnaires were used at T0 and T1: The Child Revised Impact of Events Scale, the Short Mood and Feelings Questionnaire, the Screen for Child Anxiety Related Disorders, and the Strengths and Difficulties Questionnaire. The primary outcome was prevalence of any psychiatric disorder at T1, assessed using the Development and Wellbeing Assessment. Secondary outcomes at T1 were pregnancy, sexually transmitted infections, and sexual health screening since the assault. FINDINGS: Between April 15, 2013, and April 20, 2015, 141 (29%) of 491 eligible young people were recruited to the study (134 females; mean age 15·6 years [SD 1·27]), and 106 (75%) of 141 participants had T1 interviews (99 female). At T0, psychological symptom scores showed that 115 (88%) of 130 females were at risk for depressive disorder, 90 (71%) of 126 were at risk for anxiety disorders, and 116 (91%) of 128 were at risk for post-traumatic stress disorder, with symptoms largely persisting at T1. 68 (80%) of 85 females who had a diagnostic assessment at T1 had a psychiatric disorder, with multiple disorders in 47 (55%) of 85. Anxiety, post-traumatic stress, and major depressive disorders were the commonest diagnoses. Presence of a psychiatric disorder was associated with baseline psychosocial vulnerability (previous social services involvement, mental health service use, self-harm, or sexual abuse), but not assault characteristics. At T1, four (4%) of 105 females had been pregnant since the assault, 14 (12%) of 119 had a sexually transmitted infection diagnosed between T0 and T1, and nine (8%) of 107 reported re-victimisation since the assault. INTERPRETATION: Vulnerable adolescents have the double disadvantage of being at risk for both sexual assault and associated psychiatric disorders, highlighting the need for comprehensive support after an assault. Feasibility and effectiveness of prevention programmes should be investigated. FUNDING: National Institute for Health Research Policy Research Programme grant (115/0001).