Research article
Long-Term Consequences of Childhood Sexual Abuse by Gender of Victim

https://doi.org/10.1016/j.amepre.2005.01.015Get rights and content

Background

Childhood sexual abuse (CSA) is a worldwide problem. Although most studies on the long-term consequences of CSA have focused on women, sexual abuse of both boys and girls is common. Thus, a comparison of the long-term effects of CSA by gender of the victim will provide perspective on the need for future research, prevention activities, and treatment of survivors.

Methods

A retrospective cohort study was conducted from 1995 to 1997 among 17,337 adult HMO members in San Diego, California. Participants completed a survey about abuse or household dysfunction during childhood, and multiple other health-related issues. Multivariate logistic regression was used to examine the relationships between severity of CSA (intercourse vs no intercourse) and long-term health and social problems (substance use and abuse, mental illness, and current problems with marriage and family) by gender of victim. Models controlled for exposure to other forms of adverse childhood experiences that co-occur with CSA. Among men, the relationship between the gender of the CSA perpetrator to the outcomes was also examined.

Results

Contact CSA was reported by 16% of males and 25% of females. Men reported female perpetration of CSA nearly 40% of the time, and women reported female perpetration of CSA 6% of the time. CSA significantly increased the risk of the outcomes. The magnitude of the increase was similar for men and women. For example, compared to reporting no sexual abuse, a history of suicide attempt was more than twice as likely among both men and women who experienced CSA (p<0.05). Compared with those who did not report CSA, men and women exposed to CSA were at a 40% increased risk of marrying an alcoholic, and a 40% to 50% increased risk of reporting current problems with their marriage (p<0.05).

Conclusions

In this cohort of adult HMO members, experiencing CSA was common among both men and women. The long-term impact of CSA on multiple health and social problems was similar for both men and women. These findings strongly indicate that boys and girls are vulnerable to this form of childhood maltreatment; the similarity in the likelihood for multiple behavioral, mental, and social outcomes among men and women suggests the need to identify and treat all adults affected by CSA.

Introduction

During the past several decades, research on the long-term behavioral, social, and mental health consequences of childhood maltreatment has proliferated. Studies examining the long-term effects of childhood abuse and related stressors have found increased risk for outcomes such as substance use and misuse, psychiatric disorders, suicide, and numerous other health and social problems.1, 2, 3, 4, 5, 6 Investigations of childhood sexual abuse (CSA), in particular, have received a large amount of attention. However, most studies of CSA have focused on female survivors,7, 8, 9, 10, 11 leaving a relative scarcity of information about the characteristics and long-term impact of CSA on male survivors.

Most studies of CSA prevalence indicate that girls are more likely to be victims than young boys.12 However, prevalence estimates range from 20% to 30% for females,12 and 4% to 76% for males.12, 13 For both genders, CSA risk is correlated with family-related factors such as divorce and domestic violence, and having members who abuse substances or who are emotionally unavailable.14, 15 It has also been reported that CSA commonly involves the use of force or threats.11, 16 Whereas the perpetrators of CSA among young girls are predominately male, there is increasing evidence that a notable proportion of CSA among young boys is perpetrated by females.17

Studies of CSA have demonstrated strong relationships to several negative health, behavioral, and social outcomes among male and female survivors that are currently public health priorities, which include HIV risk behaviors,18 psychiatric disorders,19, 20 substance abuse,1, 21, 22 and suicidality.23, 24 While some of these studies have used population-based samples, many have been limited to the examination of CSA among clinical samples, such as individuals in substance abuse recovery and psychiatric patients. Furthermore, studies that examine CSA in relationship to outcomes have tended to ignore the presence of other co-occurring forms of child maltreatment and many reports of CSA are almost exclusively among women.

Because there is relatively little information that compares the long-term effects of CSA among both male and female survivors, data were used from the Adverse Childhood Experiences (ACE) Study to examine the relationship of CSA and the severity of the CSA (intercourse vs nonintercourse) to the likelihood of self-reported alcohol problems, illicit drug use, suicide attempts, and current depression, as well as social outcomes such as marrying an alcoholic or having current problems with marriage and family in adult men and women. The relationship of the perpetrator’s gender to each outcome among male CSA victims was also assessed.

Section snippets

Methods

The Adverse Childhood Experiences (ACE) Study is an ongoing collaboration between Kaiser Permanente’s Health Appraisal Center (HAC) in San Diego CA and the Centers for Disease Control and Prevention and Emory University, both in Atlanta GA. The overall objective is to assess the impact of numerous adverse childhood experiences on a variety of health behaviors and outcomes and healthcare use.25 The ACE Study was approved by the institutional review boards of Kaiser Permanente, Emory University,

Characteristics of Study Population

The study population included 9367 (54%) women and 7970 (46%) men. The mean age (standard deviation) was 56 (15.2) years. Seventy-five percent of the participants were white; 39% were college graduates; 36% had some college education; and 18% were high school graduates. Only 7% had not graduated from high school (data not shown).

Characteristics of Childhood Sexual Abuse

The prevalence of each type of CSA, severity of abuse, and gender of perpetrator are shown in Table 2; 25% of women and 16% of men reported any type of CSA. Among those

Discussion

Within this large cohort of adult HMO members, a history of CSA was common among both men and women. Consistent with other reports on the prevalence of CSA, women had a slightly higher prevalence than men (25% vs 16%, respectively).45, 46, 47 It was found that the magnitude of the increased risk of alcohol problems, illicit drug use, suicide attempts, marrying an alcoholic, and current marital and family problems associated with CSA, was similar for both male and female respondents.

References (55)

  • G.E. Wyatt

    The sexual abuse of Afro-American and white American women in childhood

    Child Abuse Neglect

    (1985)
  • S.R. Dube et al.

    Assessing the reliability of retrospective reports of adverse childhood experiences among adult HMO members attending a primary care clinic

    Child Abuse Neglect

    (2004)
  • F.W. Putnam

    Ten-year research update reviewchild sexual abuse

    J Am Acad Child Adolesc Psychol

    (2003)
  • J.M. Chandy et al.

    Gender-specific outcomes for sexually abuse adolescents

    Child Abuse Neglect

    (1996)
  • D.D. Femina et al.

    Child abuseadolescent records vs adult recall

    Child Abuse Neglect

    (1990)
  • D. Finkelhor et al.

    Sexual abuse in a national survey of adult men and womenprevalence, characteristics, and risk factors

    Child Abuse Neglect

    (1990)
  • S.J. Collings

    The long-term effects of contact and noncontact forms of child sexual abuse in a sample of university men

    Child Abuse Neglect

    (1995)
  • R. Roberts et al.

    The effects of child sexual abuse in later family life; mental health, parenting and adjustment of offspring

    Child Abuse Neglect

    (2004)
  • C.F. Johnson

    Child sexual abuse

    Lancet

    (2004)
  • K.A. Kendall-Tackett et al.

    Impact of sexual abuse on childrena review and synthesis of recent empirical studies

    Psychol Bull

    (1993)
  • J.B. Kingree et al.

    Risk factors for suicide attempts among low-income women with a history of alcohol problems

    Addict Behav

    (1991)
  • P.E. Mullen et al.

    Childhood sexual abuse and mental health in adult life

    Br J Psychiatry

    (1993)
  • J.D. Osofsky

    The impact of violence on children

    Future Child

    (1999)
  • B.A. van der Kolk et al.

    Childhood origins of self-destructive behavior

    Am J Psychiatry

    (1991)
  • J. Briere et al.

    Symptomology associated with childhood sexual victimization in a nonclinical adult sample

    Child Abuse Neglect

    (1988)
  • S. Harter et al.

    Long-term effects of incestuous child abuse in college womensocial adjustment, social cognition, and family characteristics

    J Consult Clin Psychol

    (1988)
  • J. Briere et al.

    Post sexual abuse traumadata and implications for clinical practice

    J Interpersonal Violence

    (1987)
  • Cited by (673)

    View all citing articles on Scopus
    View full text