title: Childhood sexual abuse by a family member, salivary cortisol, and homicidal behavior of female prison inmates.
abstract: BACKGROUND
  Little is understood about neuropathophysiology and neuroendocrinology associated with childhood sexual abuse by a family member in females who commit homicide.
  
  
  OBJECTIVE
  To determine if females sexually abused by a family member as a child also experienced more childhood physical abuse, had more neurological histories including traumatic brain injuries (TBIs), displayed more homicidal behaviors, and had abnormal diurnal variation in the stress hormone cortisol compared with females not sexually abused by a family member.
  
  
  METHODS
  A cross-sectional study was conducted with 137 female inmates, including 9 murderers and 12 noncriminal females, with logistic regression statistical analysis comparing females who have (n = 60) and have not (n = 89) been sexually abused by a family member, as determined by Muenzenmaier's Childhood Abuse Scale.
  
  
  RESULTS
  Final multivariate logistic regression model controlling for higher numbers of incarcerated adult family members (odds ratio [OR] = 1.63, p = .01) revealed that female victims of childhood sexual abuse by a family member experienced more childhood physical abuse (OR = 1.09, p = .05), experienced more TBIs (OR = 1.49, p = .01), and displayed increased violent behaviors including homicide (OR = 1.67, p = .05) compared with those not sexually abused by a family member. In univariate analysis, females sexually abused by a family member also experienced more sexual abuse by a non-family member (OR = 1.21, p = .036), more hospital visits for abuse injuries (OR = 1.27, p = .03), and more recent abuse (OR = .95, p = .008). Childhood sexual abuse by a family member was related significantly to decreased diurnal cortisol variation (OR = .087, p = .044) when controlling for number of years since last abuse, number of incarcerated adult family members, body mass index, depression, and TBIs.
  
  
  CONCLUSIONS
  Risks associated with sexual abuse by a family member should be considered for individuals and policies to prevent potential homicide by those who experienced it. Further study is needed.
authors.affiliation: School of Nursing, College of Health Sciences, University of Delaware, Newark, DE 19716-3710, USA. kbsmyth@udel.edu
authors.forename: Kathleen
authors.initials: K
authors.lastname: Brewer-Smyth
authors.forename: Ann W
authors.initials: AW
authors.lastname: Burgess
mesh_terms: D000293:Adolescent; D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D001930:Brain Injuries / Q000209:etiology; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology* / Q000706:statistics & numerical data; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D003863:Depression / Q000145:classification / Q000209:etiology*; D005190:Family; D005260:Female; D006708:Homicide; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D016015:Logistic Models; D011329:Prisoners / Q000145:classification / Q000523:psychology*; D012463:Saliva / Q000737:chemistry
chemical_list: D006854:Hydrocortisone