Sexually abused children 5 years after presentation: a case-control study

OBJECTIVE: A total of 68 sexually abused children and their nonoffending parents were reassessed 5 years after presentation and were compared with a cohort of children of similar age and sex who were not known to have been abused. METHOD: Outcome measures were behavior, depression, self-esteem, anxiety, eating problems, drug use, suicide attempts, self-injury, running away, criminal activity, and attributional style. Recent life events, demographics, family functioning, and mothers' mental health were taken into account when examining outcome. RESULTS: Although the abused children had experienced more negative life events, were from lower socioeconomic groups, had more changes in parent figures, and had mothers who were more psychologically distressed, multiple regression analysis showed that after allowing for these and other demographic factors, there were still significant differences between the groups after the 5 years. The abused children displayed more disturbed behavior, had lower self-esteem, were more depressed or unhappy, and were more anxious than controls. Sexually abused children had significantly higher levels of bingeing, self-injury, and suicide attempts. CONCLUSIONS: It is clear that many children who are sexually abused have ongoing problems. Their ongoing problems may be indicative of false beliefs about themselves and the sexual abuse experience.     

Suicidal ideation among 8-year-olds who are maltreated and at risk: findings from the LONGSCAN studies

Suicidal ideation was examined among 1,051 8-year-old children identified as maltreated or at risk for maltreatment. Of these children, 9.9% reported suicidal ideation. Many variables, including maltreatment, had bivariate associations with suicidal ideation. Severity of physical abuse, chronicity of maltreatment, and the presence of multiple types of maltreatment strongly predicted suicidal ideation. In multivariate analyses of the domains of proximity, only ethnic background remained significant among demographic variables, only witnessed violence and maltreatment remained significant among family or contextual variables, and only child psychological distress, substance use, and poor social problem solving remained significant among child variables. The effects of ethnicity, maltreatment, and witnessed violence on suicidal ideation were mediated by child functioning. There were few interactions between maltreatment and other factors to predict suicidal ideation. Children who are maltreated and those exposed to community and domestic violence are at increased risk of suicidal ideation, even by age 8.     

Suicide attempts versus suicidal ideation in bulimic female adolescents

BACKGROUND: Suicide attempts by adolescents continue to be a major public health problem. The purpose of this study was to examine the difference in the family functioning and sociopsychopathological risk factor relationship between female bulimic adolescents with suicidal ideation only, and those who attempted suicide. METHODS: A group of 211 patients were observed for 12 months. Data from 63 subjects (SUG [suicide group], age 17.2 +/- 1.3 years) who had attempted suicide were then compared with 148 (control group, age 18.1 +/- 1.5 years) who had expressed suicidal ideation but did not follow through. RESULTS: Those in the suicide attempt group had been exposed more frequently to physical/sexual violence in childhood. As adults they either lived alone or were dissatisfied with their partnership. The frequency of borderline personality disorders and depressive disorders in this group was significant. Psychosomatic symptoms, disturbed coenesthesia, substance abuse, social impairment and interference with their perception of their own life circumstances, as well as their job performance, often preceded the suicide attempt. Nine genuine risk factors that occurred significantly more often in the SUG were calculated out of all the stress factors using stepwise logistic regression: 'as a child I was even hit with a stick or whip', 'I had no set orientation in life', 'I had a feeling of loneliness despite family and friends', 'I could not relax', 'incapable of dealing with the public', 'I do not like to be touched', 'parents have psychiatric disorders', 'misuse of stimulants', and 'as a child I felt lonely' (odds ratio, 10.56-1.90). CONCLUSION: Adverse family experiences and multiple sociopsychopathological factors may increase the risk of suicide in female bulimic adolescents.     

Where do youth learn about suicides on the Internet,and what influence does this have on suicidal ideation?

Background: Young people are susceptible to suicidal behavior as a result of learning about the suicidal behavior of others. This study was designed to determine whether Internet sites, such as online news and social networking websites, expose young people to suicide stories that might increase suicide ideation. Method: We reinterviewed 719 young people ages 14 to 24 who had participated in a prior nationally representative survey. Respondents reported knowledge of persons they knew who had committed or attempted suicide as well as personal experiences of hopelessness and suicidal ideation on both occasions. On the second occasion one year later, they also reported use of various Internet platforms and how often they had been exposed to suicide stories on those sites, as well as from personal sources. Changes in ideation as a function of exposure to different sources of suicide stories were analyzed holding constant prior hopelessness and ideation. Results: While traditional sources of information about suicide were most often cited (79% were from friends and family or newspapers), online sources were also quite common (59%). Social networking sites were frequently cited as sources, but these reports were not linked to increases in ideation. However, online discussion forums were both cited as sources and associated with increases in ideation. Conclusions: The Internet and especially social networking sites are important sources of suicide stories. However, discussion forums appear to be particularly associated with increases in suicidal ideation. Greater efforts should be undertaken to promote Internet sites directed to young people that enhance effective coping with hopelessness and suicidal ideation.     

Suicide attempts and severe psychiatric morbidity among former child welfare clients--a national cohort study

BACKGROUND: Few large sample studies have examined psychiatric morbidity among former child welfare/protection clients. In this study, risks for suicide attempts and severe psychiatric morbidity in younger years were assessed for former child welfare clients in ten national birth cohorts, comparing them with general population peers and inter-country adoptees. METHODS: We used national register data for almost one million people: 22,305 former child welfare clients who had experienced interventions before their teens, 955,326 general population cohort peers and 12,240 inter-country adoptees. Multivariate Cox regression models were used to estimate risks of hospitalisation for suicide attempts and psychiatric disorders from age 13 to age 18-27. RESULTS: Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts. They were five to eight times more likely to have been hospitalised for serious psychiatric disorders in their teens, four to six times in young adulthood. High excess risks were also found for psychoses and depression. Individuals who had been in long-term foster care tended to have the most dismal outcome. Adjusting for birth parents' hospitalisations with a psychiatric diagnosis or for substance abuse, and for birth-home-related socio-economic factors, reduced excess risks to around twofold. CONCLUSIONS: Irrespective of issues of causality, findings suggest that former child welfare/protection clients should be considered a high-risk group for suicide attempts and severe psychiatric morbidity. Results have substantial practice implications for mental health and social agencies serving this group in adolescence and/or young adulthood.     

Vulnerability or resilience to intergenerational sexual abuse: the role of maternal factors

This study examined vulnerability or resilience to intergenerational sexual abuse. The sample included 196 African American mothers and their children of which 96 were sexually abused and 100 had no reported incidents of abuse. Four groups were formed based on maternal report of a history of childhood sexual abuse and the child's abuse status: (a) sexually abused mothers of children who were not sexually abused, (b) sexually abused mothers whose child was sexually abused, (c) mothers with no history of sexual abuse whose children had no history of sexual abuse, and (d) mothers with no history of sexual abuse who had a sexually abused child. The findings indicate that mothers who break the cycle of abuse were functioning as well as the nonsexually abused mothers in the study. Furthermore, sexually abused mothers with abused children evidenced significantly more disturbed functioning than the other three groups of mothers, particularly in their attachment relationships.     

The sexually abused battered child.

A total of 130 children were identified in whom both evidence of sexual abuse and non-accidental, non-genital physical injuries (bruises, fractures, scratches, burns and scalds, including failure to thrive) were found. There were 77 girls and 53 boys with mean ages 5.7 and 6.8 years respectively and the peak age between the second and seventh birthdays; this reflects previous reports indicating that physical and sexual abuse predominantly involves young children. Patterns of injury that suggested sexually motivated assault included bruises, scratches, and burns around the lower trunk and genitalia, thighs, buttocks, and upper legs including knees. Pinch and grip marks were found where the child was held. The sexual abuse often involved attempted or achieved penetration of mouth, vagina, or anus, and physical signs were seen relatively more often than in sexually abused children as a whole. Four children died and sexual aggression and child death in the domestic setting may be linked. One in six of 769 physically abused children (16.9%) and one in seven of 949 sexually abused children (13.6%) have suffered both forms of abuse.     

Physical and Sexual Abuse and their Relation to Psychiatric Disorder and Suicidal Behavior among Adolescents who are Psychiatrically Hospitalized

Adolescents who were psychiatrically hospitalized ( N = 105) were classified as sexually abused, physically abused, both sexually and physically abused, or not abused, and studied to determine the prevalence of suicidal behavior and psychiatric disorders. Self-reports of hopelessness, depression, coping, and self-concept were also examined. No difference in suicidal behavior or psychiatric disorder, based on abuse history, was found, with one exception. Adolescents who were sexually abused, particularly those who experienced the most severe sexual abuse, used negative coping strategies more often than those not sexually abused. Findings suggest that symptomatology of adolescents who are psychiatrically hospitalized does not differ markedly based on history of abuse.     

Health risk behaviors and attempted suicide in adolescents who report prior maltreatment

We hypothesized that high school students who experienced prior maltreatment would be more likely than their peers to report health risk behaviors and suicide attempts. Before the establishment of a high school-based clinic, an anonymous needs assessment survey was completed by 600 adolescents (grades 9 to 12). Sociodemographic information was obtained and questions were asked about physical and sexual abuse, health-related behaviors and habits, and suicide attempts. Thirteen percent of the adolescents had been maltreated: 5.2% reported prior physical abuse, 5.4% sexual abuse, and 2.7% both physical and sexual abuse. Multivariate statistical techniques were used to clarify how previous abuse was related to adolescent risk-taking behaviors and suicide. Students with a history of physical abuse were three times more likely than non-abused peers to drink alcohol and smoke cigarettes, almost twice as likely to use illicit drugs, six times more likely to self-induce vomiting, and five times more likely to attempt suicide. A student with a history of prior sexual abuse had a three and one-half times greater chance of being sexually active and was more than three times more likely to attempt suicide. These data on a nonclinical, nondeviant population of adolescents indicate that physical or sexual abuse in childhood may have a significant impact on adolescent health risk behaviors and suicide attempts.     

Prevalence and characteristics of sexual abuse in a national sample of Swedish seventeen-year-old boys and girls

The aims of this study, which was part of a survey on adolescent sexual behaviour, were to investigate adolescents' experience of child sexual abuse and to present possible abuse-related problems. Representative samples of 2% of Sweden's 17-y-old male and female students and school non-attenders were selected in a two-step procedure. In all, 1943 students and 210 school non-attenders answered a self-administered anonymous questionnaire, distributed by school nurses. Six out of 170 questions dealt with personal experiences of child sexual abuse, i.e. age at onset, frequency of abuse and relationship to the offender. Peer abuse was excluded by the definitions used. The overall response rate was 92.2% for students and 44.2% for school dropouts. Among male and female students, 3.1% and 11.2%, respectively, acknowledged sexual abuse, 2.3% and 7.1%, respectively, when exhibitionism was excluded. Mean age at onset was 9.1 y (SD 4.3) for boys and 9.0 y (SD 3.9) for girls; 1.2% of the boys and 3.1% of the girls reported abusive oral, vaginal and/or anal intercourse. Suicide attempts or other acts of self-harm were reported by 33.3% of the male students reporting abuse and by 5.1% (p < 0.001) of those who had not been abused, and by 30.4% of the abused student girls compared to 9.1% of the non-abused (p < 0.001). Sleep and eating disorders, use of alcohol at an early age and/or experimentation with illicit drugs and consensual coitarche before age 15 y was reported significantly more often by abused than non-abused girls (p < 0.001, differences not found among the student boys). Of school non-attenders, 4% of the boys and 28% of the girls reported sexual abuse. Of the abused girls, 49% reported abusive vaginal intercourse and 64% reported self-destructive behaviour or suicide attempts. No abused boys and few abused girls had confided in a teacher, health professional or social worker. Results from the student sample should be interpreted as markers of "minimum prevalence", as female school non-attenders report significantly higher prevalence of sexual abuse. Potential high-risk groups are better included in prevalence investigations of child sexual abuse. The fact that so few adolescents confided in "professionals" about the abuse, despite having severe symptoms and signs of distress, underlines the need to address sexual abuse when recording the social, medical and psychiatric histories of adolescents.     

Sexually abused adolescents: A distinct group among sexually abused children presenting to a children''s hospital

Case records were retrospectively reviewed for 40 adolescents presenting to a paediatric sexual abuse service with a history of acute (23 cases) or chronic (17 cases) abuse. The chronic cases disclosed the abuse to a family member, the abuse was intrafamilial, and they had similarities to the chronically abused younger child. The acute cases disclosed the abuse outside the family, and were abused by strangers or acquaintances. Some acutely abused adolescents had similarities to child victims of stranger assault; however a larger sub-group was identified (14 of 23; 35% of total) whose indescriminate behaviour may have placed them at increased risk of abuse. They were characterized by previous contact with police and welfare agencies, alcohol/drug abuse, voluntary sexual activity, contraceptive use, genital infections and apparent indifference to the abuse. Half the total group felf emotionally unsupported, and four subsequently attempted suicide. This study identifies unique problems of sexually abused adolescents, and recognizes potential multiple problems in those acutely abused.     

Abuse, feelings, and health behaviors in a student population

Behavioral sequelae of child abuse are frequently cited, but there are few studies that examine the strength of association between behavioral effect and abuse for children in a nonclinical setting. Seven hundred twelve junior high school students (mean age, 13.5 years) were surveyed for self-report of personal experience with abuse, certain health behaviors, and self-esteem. Physical and/or sexual abuse was reported by 18.3% of students. Both types of abuse were associated with the following behaviors: running away; considering hurting oneself; suicide attempts; and the use of drugs, pot (marijuana), cigarettes, and laxatives. No clinically significant relationships were found between abuse and report of anger, sadness, or self-esteem. These data suggested that some feelings and behaviors were common among all adolescents sampled, while others were more common among abused adolescents. Recognition of strong associations should help direct clinical management. The results of this study confirm findings from some previous reports and indicate the need for further studies of children who are not in a clinical setting.     

Sexual abuse of human immunodeficiency virus-positive children. Outcomes for perpetrators and evaluation of other household children.

OBJECTIVE--To obtain the following data that pertain to programs for the prevention of sexual abuse and sexual transmission of human immunodeficiency virus (HIV) to children: (1) to determine the prevalence of sexual abuse among siblings and other children cohabiting with sexually abused HIV-positive children, and (2) to determine if programs designed to restrain identified perpetrators from further acts of child sexual abuse were instituted. DESIGN--Case series. SETTING--Households of previously described sexually abused HIV-infected children. PATIENTS AND OTHER PARTICIPANTS--Twenty-two siblings or other children who lived in the homes of 14 previously described HIV-infected sexually abused children. Eight perpetrators of the abuse were identified. MAIN OUTCOME MEASURES--Sexual abuse of cohabiting children was confirmed with disclosure interviews, witness by other persons, diagnosis of another sexually transmitted disease, or an abnormal physical examination result that was highly suggestive of sexual abuse. Telephone contact with the Department of Social Services, county sheriff or police, and district attorney provided data regarding reports, criminal indictments, trials, convictions, and plea-bargain arrangements for the identified perpetrators. RESULTS--Eleven (50%) of the 22 cohabiting children were confirmed to have been sexually abused and four (18%) were suspected of having been sexually abused. Seven (32%) of the cohabiting children could not be examined and it was not known if they had been sexually abused. No assailant was tried for a criminal offense, required to participate in offender therapy, or prohibited from unsupervised visitation of children. CONCLUSION--Programs for the prevention of sexual abuse and sexual transmission of HIV to children require means of ensuring the safety of children exposed to perpetrators and require adequate supervision of perpetrators and their adherence to therapy.     

Tentative de suicide : comment repérer un adolescent en danger ?

In the majority of the Western countries, death by suicide became the second cause of death to adolescence after car accidents. Every year in France, more than 500 young people commit suicide and 6.5% of secondary school youths made a suicide attempt. Thus, detecting teenagers with a high suicidal risk is a significant objective for any doctor. But often, psychic suffering progresses unseen: behavioural problems, somatizations, repeated accidents⋯ How to broach the subject during an ordinary consultation? Doctors can, for example, lean on the Binder test to detect suicidal ideation and evaluate its seriousness.     

Substance use and suicidal conduct: a study of adolescents hospitalized for suicide attempt and ideation

AIM: To study the prevalence of psychoactive substance use disorder (PSUD) among suicidal adolescents, psychoactive substance intoxication at the moment of the attempt, and the association between PSUD at baseline and either occurrence of suicide or repetition of suicide attempt(s). METHODS: 186 adolescents aged 16 to 21 y hospitalized for suicide attempt or overwhelming suicidal ideation were included (T0); 148 of them were traced again for evaluations after 6 mo (T1) and/or 18 mo (T2). DSM-IV diagnoses were assessed each time using the Mini International Neuropsychiatric Interview. RESULTS: At T0, 39.2% of the subjects were found to have a PSUD. Among them, a significantly higher proportion was intoxicated at the time of the attempt than those without PSUD (44.3% vs 25.4%). Among the 148 adolescents who could be traced at either T1 or T2, two died from suicide and 30 repeated suicide attempts once or more times. A marginally significant association was found between death by suicide/repetition of suicide attempt and alcohol abuse/dependence at baseline (OR=3.3, 95% CI 0.7-15.0; OR=2.6, 95% CI 0.7-9.3). More than one suicide attempt before admission to hospital at T0 (OR=3.2, 95% CI 1.1-10.0) and age over 19 y at T0 (OR=3.2, 95% CI 1.1-9.2) were independently associated with the likelihood of death by suicide or repetition of suicide attempt. CONCLUSION: Among adolescents hospitalized for suicide attempt or overwhelming suicidal ideation, the risk of death or repetition of attempt is high and is associated with previous suicide attempts--especially among older adolescents--and also marginally associated with PSUD; these adolescents should be carefully evaluated for such risks and followed up once discharged from the hospital.     

Risk factors for suicidal behavior in adolescents

Adolescent suicide is today a public health problem among the leading cause of mortality among adolescents and young adults. There seems to be many reasons for this increase (which has different trends in different populations), but associations have been found with increased substance abuse, television and video violence, socio-economic status and easy access to firearms. Gender differences have also been observed with crime, suicide and substance abuse higher among males, while eating disorder, depression and suicidal behavior more prevalent among females. This paper will review prevalence and incidence of adolescent suicidal behavior, socio-demographic and psychological risk factors, associated cognitive factors and socio-economic factors. Risk factors include previous suicide attempts, a history of others in the family who have been suicidal, mental illness, alcohol and drug use, and other self-destructive behaviors as well as consideration being given to hopelessness, hostility, negative self-concept and isolation. At the individual difference level, factors such as trait depression, anger and hostility, perfectionism and social sensitivity would seem critical variables, as would age, gender and intellectual functioning. Sociological and family-related factors may also be implicated including dysfunctional family organizations, a history of physical or psychological abuse (sexual abuse) and limited extent of social support networks. A frequently reported precipitating event of suicidal behavior is family adversity including rejection, separation and interpersonal conflict. At a socio-economic level it would seem essential to provide comprehensive document about the social and economic conditions from which the adolescent comes.     

Suicidal behaviors in adolescents

Objective. Suicidal ideation and suicide attempt are generally considered as non-fatal suicidal behaviors (NFSB) by most researchers. Across different cultures, the prevalence of NFSB has been found to be alarmingly high among adolescents. As there is no published study estimating prevalence rates in India, we conducted a study on adolescents in Delhi to find prevalence of NFSB and other related behaviors and to identify risk factors for NFSB.Methods: We collected data from 1205 adolescents in the age group from 12 to 19 years from 2 schools through semi-structured questionnaire on demographic variables, NFSB, death wish, deliberate self harm (DSH), Adjustment Inventory for School Students (AISS) by Sinha et al. & BDI.Results: Prevalence of suicidal ideation (lifetime), suicidal ideation (last year), suicide attempt (lifetime), suicide attempt (last year) were 21.7%, 11.7%, 8% and 3.5%, respectively. All the significant variables were entered into a logistic regression analysis model, and the adjusted odds ratios, with 95% confidence intervals, were obtained for them. Hindu religion, female sex, older adolescent, physical abuse by parents, feeling neglected by parents, history of running away from school, history of suicide by a friend, death wish and DSH were found to be significant risk factors for NFSB.Conclusions: There is high prevalence of suicidal ideation, suicide attempt, death wish and deliberate self-harm in adolescent population of two schools in Delhi. Clinical implications of these findings are discussed.     

The prevalence of unwanted and unlawful sexual experiences reported by Danish adolescents: results from a national youth survey in 2002

AIM: To obtain current data about child sexual abuse in Denmark and to assess abused children's own perception of early sexual experiences, which are unlawful according to the Danish Penal Code. METHODS: Multimedia computer-based self-administered questionnaires (CASI) were completed by a national representative sample of 15-16-y-olds. Child sexual abuse was defined according to the penal code and measured by questions defining specific sexual activities, the relationship between the older person and the child, and the youth's own perception of the incident. RESULTS: Among 5829 respondents, 11% reported unlawful sexual experiences, 7% of boys and 16% of girls. Only 1% of boys and 4% of girls felt that they "definitely" or "maybe" had been sexually abused. CONCLUSION: A relatively high percentage of Danish adolescents have early, unlawful sexual experiences. However, young people's own perception of sexual abuse tends to differ from that of the authorities, or their tolerance of abusive incidents is high. Gender differences were found in factors predicting perception of abuse.     

Diagnostic findings in alleged sexual abuse: symptoms have no predictive value

AIMS: To describe demographic characteristics and trends, indications for referral and medical findings in children and young people seen for suspected sexual abuse. METHODS: Retrospective review of consecutive medical records over a 7-year period. RESULTS: A total of 2310 new patients were seen for concerns about sexual abuse and/or genital symptoms, resulting in 2162 genital examinations, of which 2134 were statistically analysed. The age ranged from 1 month to 17 years, with peaks at 3 and 14 years. Eighty-six percent were female. Most were referred by statutory authorities, with a marked reduction in referral numbers from 1997. Where a perpetrator was described, 97% were male and 92% were family members or friends. Medical findings diagnostic of sexual abuse were found in 130 cases (6%). Diagnostic findings were more likely to be found in adolescent girls. For the most part, physical symptoms were of no value in differentiating between those who had been sexually abused and those who had not. CONCLUSIONS: The demographics are concordant with the literature. The reduction in referrals may reflect changes in practice by statutory authorities. In pre-pubertal children, referrals were often made on the basis of physical symptoms, which have no predictive value in the diagnosis of sexual abuse.