Psychopathology in a large cohort of sexually abused children followed up to 43 years.
OBJECTIVE
To determine the rate and risk of clinical and personality disorders diagnosed in childhood and adulthood in those known to have been sexually abused during childhood.


METHODS
Forensic medical records of 2,759 sexually abused children assessed between 1964 and 1995 were linked with a public psychiatric database between 12 and 43 years later. Cases were compared to control subjects matched on gender and age groupings drawn from the general population through a random sample of the national electoral database.


RESULTS
A lifetime record of contact with public mental health services was found in 23.3% of cases compared to 7.7% of controls. The rate of contact among child sexual abuse victims was 3.65 times higher (95% CI, 3.09-4.32, p<0.001). It was estimated that child sexual abuse accounted for approximately 7.83% of mental health contact. Exposure to sexual abuse increased risks for the majority of outcomes including psychosis, affective, anxiety, substance abuse, and personality disorders. Rates of clinical disorders diagnosed in adulthood and childhood remained significantly higher among child sexual abuse cases. Older age at sexual abuse and those exposed to severe abuse involving penetration or multiple offenders were associated with greater risk for psychopathology.


CONCLUSIONS
This study confirms that child sexual abuse is a substantial risk factor for a range of mental disorders in both childhood and adulthood.


CONCLUSIONS
Those treating victims of sexual abuse must assess not only disorders commonly associated with trauma, but also low prevalence disorders such as psychosis.
Cutajar
Margaret C
MC
Centre for Forensic Behavioural Science, Monash University, 505 Hoddle Street, Clifton Hill, Melbourne, VIC 3068, Australia.
Mullen
Paul E
PE
Ogloff
James R P
JR
Thomas
Stuart D
SD
Wells
David L
DL
Spataro
Josie
J
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008498:Medical Record Linkage; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology* / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011599:Psychopathology; D012307:Risk Factors; D017678:Sex Distribution; D012747:Sexual Partners; D014739:Victoria / Q000453:epidemiology