title: The long-term co-occurrence of psychiatric illness and behavioral problems following child sexual abuse.
abstract: OBJECTIVE
  There is a growing body of research investigating the relationship between child sexual abuse and a range of adverse outcomes. However, very little is known about the long-term co-occurrence of psychiatric disorders and behavioral problems among this vulnerable population, or the interaction between characteristics of the abuse, such as the nature and timing of the child sexual abuse, and the extent of subsequent adversities. This study aimed to determine the rate and co-occurrence of mental health morbidity, criminal justice system contact, and fatal self-harm among medically confirmed victims of child sexual abuse, and to identify abuse variables associated with a greater likelihood of cumulative adverse experiences.
  
  
  METHODS
  The forensic medical records of 2759 cases of child sexual abuse assessed between 1964 and 1995 were linked with public psychiatric, criminal justice and coronial administrative databases between 13 and 44 years following abuse. Cases were compared to 2677 matched comparisons from the general population.
  
  
  RESULTS
  Abuse victims were more likely (odds ratio = 7.2, 95% confidence interval = [4.9, 10.4], p < 0.001) to experience cumulative adverse psychiatric and behavioral problems relative to comparisons. Almost half (47.6%) of victims who died of suicide or drug overdose had a history of offending, further victimization and mental illness. Relative to comparisons, female victims demonstrated the largest increase in odds for cumulative outcomes (odds ratio = 9.8, 95% confidence interval = [5.8, 16.8], p < 0.001), whereas in absolute terms, male victims were at an elevated risk for all types and combinations of adverse outcomes, except fatal self-harm. Boys who were older at abuse, had multiple abuse episodes or who were abused by an extra-familial perpetrator were most likely to experience poorer clinical trajectories. Only being older at abuse was associated with cumulative adverse experiences for females.
  
  
  CONCLUSIONS
  Sexual abuse, particularly during adolescence (ages 12-16 years), appears to be a risk factor for co-occurring adverse experiences. This study identifies particular groups of child sexual abuse victims as at-risk and requiring targeted intervention.
authors.affiliation: 1 Centre for Forensic Behavioural Science, Swinburne University of Technology, Clifton Hill, VIC, Australia.|2 Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, VIC, Australia.
authors.forename: Nina L
authors.initials: NL
authors.lastname: Papalia
authors.affiliation: 1 Centre for Forensic Behavioural Science, Swinburne University of Technology, Clifton Hill, VIC, Australia.|2 Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, VIC, Australia.
authors.forename: Stefan
authors.initials: S
authors.lastname: Luebbers
authors.affiliation: 1 Centre for Forensic Behavioural Science, Swinburne University of Technology, Clifton Hill, VIC, Australia.|2 Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, VIC, Australia.
authors.forename: James Rp
authors.initials: JR
authors.lastname: Ogloff
authors.affiliation: 1 Centre for Forensic Behavioural Science, Swinburne University of Technology, Clifton Hill, VIC, Australia.|2 Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, VIC, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Cutajar
authors.affiliation: 1 Centre for Forensic Behavioural Science, Swinburne University of Technology, Clifton Hill, VIC, Australia.|2 Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, VIC, Australia.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Mullen
mesh_terms: D000293:Adolescent; D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D000367:Age Factors; D016022:Case-Control Studies; D003416:Criminal Law / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology*; D000066553:Problem Behavior / Q000523:psychology*; D012737:Sex Factors; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: Child sexual abuse; crime victims; long-term adverse effects; mental health; problem behavior