Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis

Laura P Chen, M Hassan Murad, Molly L Paras, Kristina M Colbenson, Amelia L Sattler, Erin N Goranson, Mohamed B Elamin, Richard J Seime, Gen Shinozaki, Larry J Prokop, Ali Zirakzadeh, Laura P Chen, M Hassan Murad, Molly L Paras, Kristina M Colbenson, Amelia L Sattler, Erin N Goranson, Mohamed B Elamin, Richard J Seime, Gen Shinozaki, Larry J Prokop, Ali Zirakzadeh

Abstract

Objective: To systematically assess the evidence for an association between sexual abuse and a lifetime diagnosis of psychiatric disorders.

Patients and methods: We performed a comprehensive search (from January 1980-December 2008, all age groups, any language, any population) of 9 databases: MEDLINE, EMBASE, CINAHL, Current Contents, PsycINFO, ACP Journal Club, CCTR, CDSR, and DARE. Controlled vocabulary supplemented with keywords was used to define the concept areas of sexual abuse and psychiatric disorders and was limited to epidemiological studies. Six independent reviewers extracted descriptive, quality, and outcome data from eligible longitudinal studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I(2) statistic was used to assess heterogeneity.

Results: The search yielded 37 eligible studies, 17 case-control and 20 cohort, with 3,162,318 participants. There was a statistically significant association between sexual abuse and a lifetime diagnosis of anxiety disorder (OR, 3.09; 95% CI, 2.43-3.94), depression (OR, 2.66; 95% CI, 2.14-3.30), eating disorders (OR, 2.72; 95% CI, 2.04-3.63), posttraumatic stress disorder (OR, 2.34; 95% CI, 1.59-3.43), sleep disorders (OR, 16.17; 95% CI, 2.06-126.76), and suicide attempts (OR, 4.14; 95% CI, 2.98-5.76). Associations persisted regardless of the victim's sex or the age at which abuse occurred. There was no statistically significant association between sexual abuse and a diagnosis of schizophrenia or somatoform disorders. No longitudinal studies that assessed bipolar disorder or obsessive-compulsive disorder were found. Associations between sexual abuse and depression, eating disorders, and posttraumatic stress disorder were strengthened by a history of rape.

Conclusion: A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders.

Figures

FIGURE 1.
FIGURE 1.
Literature search and study selection process. PTSD = posttraumatic stress disorder. * Literature search included somatic outcomes reported elsewhere.
FIGURE 2.
FIGURE 2.
Odds ratio (OR) of the association between sexual abuse (SA) and lifetime diagnosis of anxiety. CI = confidence interval; F = female; M = male.
FIGURE 3.
FIGURE 3.
Odds ratio (OR) of the association between sexual abuse (SA) and lifetime diagnosis of depression. CI = confidence interval; F = female; M = male.
FIGURE 4.
FIGURE 4.
Odds ratio (OR) of the association between sexual abuse (SA) and lifetime diagnosis of suicide attempts. CI = confidence interval; F = female; M = male.
FIGURE 5.
FIGURE 5.
Odds ratio (OR) of the association between sexual abuse (SA) and lifetime diagnosis of eating disorders. CI = confidence interval; F = female; M = male.
FIGURE 6.
FIGURE 6.
Odds ratio (OR) of the association between sexual abuse (SA) and lifetime diagnosis of posttraumatic stress disorder. CI = confidence interval.
FIGURE 7.
FIGURE 7.
Odds ratio (OR) of the association between sexual abuse (SA) and lifetime diagnosis of schizophrenia. CI = confidence interval; F = female; M = male.
FIGURE 8.
FIGURE 8.
Odds ratio (OR) of the association between sexual abuse (SA) and lifetime diagnosis of sleep disorders. CI = confidence interval.
FIGURE 9.
FIGURE 9.
Odds ratio (OR) of the association between sexual abuse (SA) and lifetime diagnosis of somatoform disorders. CI = confidence interval.

Source: PubMed

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