Social and emotional outcomes of childhood sexual abuse: A review of recent research
Introduction
The number of children who experience child sexual abuse has sharply increased in recent years. According to the third national incidence study of child abuse and neglect (Sedlak & Broadhurst, 1996), over 300,000 children were sexually abused in 1993. Although there are no reliable statistics on how many cases of childhood sexual abuse occur that each year, it is estimated that one in four girls and 1 in 10 boys will suffer from victimization (Finkelhor, 1993). The risk for sexual abuse rises in pre-adolescence and girls are at higher risk compared to boys. Statistics on childhood sexual abuse only exist for those cases that are reported to child protection agencies or law enforcement offices. According to Finkelhor (1994), the actual number of cases being reported to child abuse authorities is 2.4/1000.
While only 15% of child sexual abuse cases has been substantiated (Finkelhor, 1994), the actual number of cases is expected to be much higher since sexual abuse is under-reported by both male and female children (Becker, 1988). Studies report a range anywhere from 12% (Bayatpour, Wells, & Holford, 1992) to percentages as high as 54% among females vs. 15% of males (Kellogg & Hoffman, 1997). Although the estimated rates vary across studies, the clear pattern is for high rates of abuse.
The purpose of this paper is to review recent research on the short-term effects of childhood sexual abuse and also to examine the extent to which previous methodological concerns noted in prior reviews of the literature (cf., Beitchman et al., 1991, Browne & Finkelhor, 1986, Kendall-Tackett et al., 1993, Trickett & Putnam, 1998) have been addressed in more recent studies.
In the present review, the majority of respondents used in these studies are between 12 and 18 years of age. It is important to note that, occasionally, samples overlap in terms of the outcome variables. A few studies include findings on both sexual abuse and physical abuse. In these cases, only the results associated with sexual abuse are presented. Studies in which physical and sexual abuses were combined into a single abuse category were excluded. Only quantitative studies were reviewed with, the majority being published within the last 4 or 5 years. Studies that employed very few subjects, case studies, or both children and adults in their sample were also excluded. Only those investigations that included social and/or emotional outcomes were reviewed. These studies drew their samples from a variety of sources such as detention centers, inpatient centers, children's hospitals, and prenatal clinics.
Results of the studies are presented by outcome variable and listed separately due to the diversity of findings. Results are then summarized by developmental period, and then the use of intervening variables is examined. Finally, the limitations of existing findings are discussed followed by direction for future research.
Section snippets
Suicide and substance use
Many investigations have focused on substance use and suicide as potential outcomes of early sexual abuse. Two studies, which focused exclusively on females, were reviewed. Bayatpour et al. (1992) examined the association between abuse and drug use and suicidality among a sample of 352 racially diverse pregnant teens ages 12–19 years enrolled in a prenatal clinic. Their results indicated that those who were sexually abused were at increased risk for suicide as well as suicide ideation compared
Summary by developmental period
The research findings are summarized below by developmental period. The three developmental periods include: infancy and early childhood (birth to age 6), middle childhood (6–12 years), and adolescence (approximately 13–17 years; see Trickett & Putnam, 1998). Many of the studies reviewed encompassed larger age ranges than those listed above. In such cases, the mean age of the group was used for placement within a particular developmental period.
Limitations of existing research
Although some of the previous limitations listed in earlier reviews of the literature have begun to be addressed (e.g., including both males and females and more diverse samples), many of the same limitations still exist. Such limitations are organized into the following categories: samples, study design, measures, and theory and are discussed below.
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