Prevalence of physical, psychological, and sexual abuse among a nationwide sample of Arab high school students: association with family characteristics, anxiety, depression, self-esteem, and quality of life

Abstract

Objectives

The objectives were first, to assess the lifetime and 12-month prevalence of physical, psychological, and sexual abuse among a stratified random sample of Kuwaiti high school students and second, to explore the association of child abuse with parental characteristics, subjective quality of life (QOL), self-esteem, anxiety, and depression.

Method

We assessed the students for experience of abuse by their mothers, fathers, and others, using standard scales on psychological, physical and sexual abuse. They also completed the short version of the World Health Organization’s QOL Instrument; the Rosenberg self-esteem scale, and a scale for anxiety and depression.

Results

We obtained responses from 4,467 students (49% boys), mean age 16.9 years. About 18, 15, and 18%, indicated that for at least six times in the past 12 months, they experienced psychological abuse by their mothers, fathers and others, respectively. The corresponding figures for lifetime experience were similar. The respective figures for experience of physical abuse during the past 12 months were 4.3, 5.8, and 6.4%. For lifetime experience, the corresponding figures were 3.4, 5.3, and 5.8%. The girls had significantly higher physical/psychological abuse scores. There were no significant gender differences in the prevalence of sexual attacks (8.6%) and someone threatening the subjects with sex (5.9%). The prevalence of someone sexually exposing themselves to the students (15.3%) and unwanted touching of sexual parts (17.4%) was significantly higher among the boys. Over one-third of those abused had experienced multiple abuses. Child abuse was significantly associated with parental divorce, diminished QOL and self-esteem, high scores on anxiety/depression, and difficulty with studies, and social relationships. In the regression analysis involving only the abuse indices, psychological abuse by mothers was the most important predictor of depression, anxiety, and self-esteem (11.5–19.7% of variance). Good quality of parental relationship seemed protective.

Conclusion

The findings support the impression that, despite the conservative culture, child abuse is being experienced by a significant number of children in the Arab world. Preventive education in this culture should include limits on child disciplinary measures, the vulnerable groups identified, the impact on psychosocial functioning, and the protective effect of parental harmony.

Appendices

Appendix: Physical and psychological maltreatment among high school students and its impact on well-being

Please answer all questions in this questionnaire. There are no right or wrong answers. If you have difficulty answering any of these questions, please ask the person who has given you the questionnaire.

Appendix 1

Physical and psychological maltreatment: modified from Briere and Runtz (1988)

• (1) Psychological

  • (a) Verbal arguments and punishment can possibly range from a mere disagreement to yelling, insulting, or even severe behavior. As far as you can remember, how often did the following things ever happen to you in the average year with the most intense experience (i.e., beyond the past year)? Please answer as it relates to your father, mother, and significant others (i.e., other family members, friends, house maid, etc.) by using the following code:

    • (0) Never

    • (1) Once a year

    • (2) 2–5 times a year

    • (3) 6–10 times per year

    • (4) More than 10 times per year

 

	Mother					Father					Others ()
a) Yell at you	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
b) Insult you	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
c) Criticize you	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
d) Try to make you feel guilty	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
e) Ridicule or humiliate you	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
f) Embarrass you in front of others	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
g) Make you feel like you were a bad person	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4

• (b) During the past year (i.e. past 12 months only), how often did the following things happen to you? Please answer as it relates to your father, mother, and significant others (i.e., other family members, friends, house maid, etc.) by using the following code:

  • (0) Never

  • (1) Once in past 12 months

  • (2) 2–5 times in past 12 months

  • (3) 6–10 times per year

  • (4) More than 10 times per year

 

	Mother					Father					Others ()
(a) Yell at you	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
(b) Insult you	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
(c) Criticize you	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
(d) Try to make you feel guilty	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
(e) Ridicule or humiliate you	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
(f) Embarrass you in front of others	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
(g) Make you feel like you were a bad person	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4

• (2) Physical

  • (a) Every person gets into conflicts with other people, and sometimes these conflicts lead to violent behavior. As far as you can remember, how often did the following things ever happen to you in the average year (beyond the past year)? Please answer as it relates to your father, mother, and significant others (i.e., other family member, friends, house maid, etc.) by using the following code:

    • (0) Never

    • (1) Once in past 12 months

    • (2) 2–5 times in past 12 months

    • (3) 6–10 times per year

    • (4) More than 10 times per year

 

	Mother					Father					Others ()
(a) Slap you	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
(b) Push you hard	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
(c) Pull your hair	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
(d) Beat you with objects such as Agal, belt, stick	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4

• (b) During the past year (i.e. past 12 months only), how often did the following events happen to you? Please answer as it relates to your father, mother, and significant others (i.e., other family members, friends, house maid, etc.) by using the following code:

  • (0) Never

  • (1) Once in past 12 months

  • (2) 2–5 times in past 12 months

  • (3) 6–10 times per year

  • (4) More than 10 times per year

 

	Mother					Father					Others ()
(a) Slap you	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
(b) Push you hard	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
(c) Pull your hair	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4
(d) Beat you with objects such as Agal, belt, stick	0	1	2	3	4	0	1	2	3	4	0	1	2	3	4

Appendix 2: modified from MacMillan et al. (1997)

• (3) As far as you can remember, did any adult ever do any of the following things to you:

 

	Yes	No
(a) Deliberately exposed themselves to you more than once to attract your attention ?
(b) Threatened to have sex with you?
(c) Touched the sex parts of your body to arouse you?
(d) Tried to have sex with you or sexually attacked you?

• (e) If any of these happened to you, please state the type of person who did it by putting an “X” in the appropriate box below. You can choose more than one, as appropriate

1. Father 2. Mother 3. Brother 4. Sister 5. Maid 6. Relatives