Research articleLong-Term Consequences of Childhood Sexual Abuse by Gender of Victim
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.
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