Long-term outcomes of childhood sexual abuse: an umbrella review

Helen P Hailes, Rongqin Yu, Andrea Danese, Seena Fazel, Helen P Hailes, Rongqin Yu, Andrea Danese, Seena Fazel

Abstract

Background: Although many meta-analyses have examined the association between childhood sexual abuse and subsequent outcomes, the scope, validity, and quality of this evidence has not been comprehensively assessed. We aimed to systematically review existing meta-analyses on a wide range of long-term psychiatric, psychosocial, and physical health outcomes of childhood sexual abuse, and evaluate the quality of the literature.

Methods: In this umbrella review, we searched four databases (PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Global Health) from inception to Dec 31, 2018, to identify meta-analyses of observational studies that examined the association between childhood sexual abuse (before 18 years of age) and long-term consequences (after 18 years). We compared odds ratios (ORs) across different outcomes. We also examined measures of quality, including heterogeneity between studies and evidence for publication bias. This study is registered with PROSPERO, CRD42016049701.

Findings: We identified 19 meta-analyses that included 559 primary studies, covering 28 outcomes in 4 089 547 participants. Childhood sexual abuse was associated with 26 of 28 specific outcomes: specifically, six of eight adult psychiatric diagnoses (ORs ranged from 2·2 [95% CI 1·8-2·8] to 3·3 [2·2-4·8]), all studied negative psychosocial outcomes (ORs ranged from 1·2 [1·1-1·4] to 3·4 [2·3-4·8]), and all physical health conditions (ORs ranged from 1·4 [1·3-1·6] to 1·9 [1·4-2·8]). Strongest psychiatric associations with childhood sexual abuse were reported for conversion disorder (OR 3·3 [95% CI 2·2-4·8]), borderline personality disorder (2·9 [2·5-3·3]), anxiety (2·7 [2·5-2·8]), and depression (2·7 [2·4-3·0]). The systematic reviews for two psychiatric outcomes (post-traumatic stress disorder and schizophrenia) and one psychosocial outcome (substance misuse) met high quality standards. Quality was low for meta-analyses on borderline personality disorder and anxiety, and moderate for conversion disorder. Assuming causality, population attributable risk fractions for outcomes ranged from 1·7% (95% CI 0·7-3·3) for unprotected sexual intercourse to 14·4% (8·8-19·9) for conversion disorder.

Interpretation: Although childhood sexual abuse was associated with a wide range of psychosocial and health outcomes, systematic reviews on only two psychiatric disorders (post-traumatic stress disorder and schizophrenia) and one psychosocial outcome (substance misuse) were of a high quality. Whether services should prioritise interventions that mitigate developing certain psychiatric disorders following childhood abuse requires further review. Higher-quality meta-analyses for specific outcomes and more empirical studies on the developmental pathways from childhood sexual abuse to later outcomes are necessary.

Funding: Wellcome Trust.

Conflict of interest statement

Declaration of interests

We declare no competing interests.

Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1. Study selection
Figure 1. Study selection
CINAHL=Cumulative Index to Nursing and Allied Health Literature.
Figure 2. Risk estimates of long-term outcomes…
Figure 2. Risk estimates of long-term outcomes following childhood sexual abuse

References

    1. Stoltenborgh M, van Ijzendoorn MH, Euser EM, Bakermans-Kranenburg MJ. A global perspective on child sexual abuse: meta-analysis of prevalence around the world. Child Maltreat. 2011;16:79–101.
    1. Arriola KR, Louden T, Doldren MA, Fortenberry RM. A meta-analysis of the relationship of child sexual abuse to HIV risk behavior among women. Child Abuse Negl. 2005;29:725–46.
    1. Jespersen AF, Lalumiere ML, Seto MC. Sexual abuse history among adult sex offenders and non-sex offenders: a meta-analysis. Child Abuse Negl. 2009;33:179–92.
    1. Liu RT. Childhood maltreatment and impulsivity: a meta-analysis and recommendations for future study. J Abnorm Child Psychol. 2018 doi: 10.1007/s10802-018-0445-3. published online May 30.
    1. Amado BG, Arce R, Herraiz A. Psychological injury in victims of child sexual abuse: a meta-analytic review. Psychosoc Interv. 2015;24:49–62.
    1. Chen LP, Murad MH, Paras ML, et al. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc. 2010;85:618–29.
    1. Varese F, Smeets F, Drukker M, et al. Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophr Bull. 2012;38:661–71.
    1. Lloyd S, Operario D. HIV risk among men who have sex with men who have experienced childhood sexual abuse: systematic review and meta-analysis. AIDS Educ Prev. 2012;24:228–41.
    1. Danese A, Tan M. Childhood maltreatment and obesity: systematic review and meta-analysis. Mol Psychiatry. 2014;19:544–54.
    1. Newbury JB, Arseneault L, Moffitt TE, et al. Measuring childhood maltreatment to predict early-adult psychopathology: comparison of prospective informant-reports and retrospective self-reports. J Psychiatr Res. 2018;96:57–64.
    1. Reuben A, Moffitt TE, Caspi A, et al. Lest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health. J Child Psychol Psychiatry. 2016;57:1103–12.
    1. Maniglio R. Child sexual abuse in the etiology of depression: a systematic review of reviews. Depress Anxiety. 2010;27:631–42.
    1. Maniglio R. Child sexual abuse in the etiology of anxiety disorders: a systematic review of reviews. Trauma Violence Abuse. 2013;14:96–112.
    1. Maniglio R. The role of child sexual abuse in the etiology of suicide and non-suicidal self-injury. Acta Psychiatr Scand. 2011;124:30–41.
    1. Maniglio R. The role of child sexual abuse in the etiology of substance-related disorders. J Addict Dis. 2011;30:216–28.
    1. Hillberg T, Hamilton-Giachritsis C, Dixon L. Review of meta-analyses on the association between child sexual abuse and adult mental health difficulties: a systematic approach. Trauma Violence Abuse. 2011;12:38–49.
    1. Maniglio R. The impact of child sexual abuse on health: a systematic review of reviews. Clin Psychol Rev. 2009;29:647–57.
    1. WHO. Global health estimates 2014 summary tables. Geneva: World Health Organization; 2014.
    1. US National Institute of Mental Health. Global DALYs contributed by mental and behavioral disorders. [accessed Nov 1, 2016];2010 .
    1. Hemmingsson E, Johansson K, Reynisdottir S. Effects of childhood abuse on adult obesity: a systematic review and meta-analysis. Obes Rev. 2014;15:882–93.
    1. Jumper SA. A meta-analysis of the relationship of child sexual abuse to adult psychological adjustment. Child Abuse Negl. 1995;19:715–28.
    1. Li M, D’Arcy C, Meng X. Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: systematic review, meta-analysis, and proportional attributable fractions. Psychol Med. 2016;46:717–30.
    1. Lindert J, von Ehrenstein OS, Grashow R, Gal G, Braehler E, Weisskopf MG. Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis. Int J Public Health. 2014;59:359–72.
    1. Mandelli L, Petrelli C, Serretti A. The role of specific early trauma in adult depression: a meta-analysis of published literature. Childhood trauma and adult depression. Eur Psychiatry. 2015;30:665–80.
    1. Roodman AA, Clum GA. Revictimization rates and method variance: a meta-analysis. Clin Psychol Rev. 2001;21:183–204.
    1. Smolak L, Murnen SK. A meta-analytic examination of the relationship between child sexual abuse and eating disorders. Int J Eat Disord. 2002;31:136–50.
    1. Wang Y, Wu B, Yang H, Song X. The effect of childhood abuse on the risk of adult obesity. Ann Clin Psychiatry. 2015;27:175–84.
    1. Dagang SA. A meta-analytic review of studies examining the effects of childhood sexual abuse in women. Diss Abstr Int Sect B Sci Eng. 1997;57:4701.
    1. Sundin EC, Baguley T. Prevalence of childhood abuse among people who are homeless in Western countries: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2015;50:183–94.
    1. Hailes HP, Fazel S, Yu R. Longterm outcomes of childhood sexual abuse: an umbrella review. PROSPERO Int Prospect Regist Syst Rev. 2016 CRD42016049701.
    1. Borenstein M. Effect sizes for continuous data. In: Cooper H, Hedges LV, Valentine JC, editors. The handbook of research synthesis and meta-analysis. 2nd edn. New York, NY: Russell Sage Foundation; 2009. pp. 221–36.
    1. Polanin JR, Tanner-Smith EE, Hennessy EA. Estimating the difference between published and unpublished effect sizes: a meta-review. Rev Educ Res. 2016;86:207–36.
    1. Zhang J, Yu KF. What’s the relative risk?: A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280:1690–91.
    1. Rockhill B, Newman B, Weinberg C. Use and misuse of population attributable fractions. Am J Public Health. 1998;88:15–19.
    1. Barth J, Bermetz L, Heim E, Trelle S, Tonia T. The current prevalence of child sexual abuse worldwide: a systematic review and meta-analysis. Int J Public Health. 2013;58:469–83.
    1. von Ins FR, Mikton C, Finkelhor D, et al. Promoting research to prevent child maltreatment; XIXth ISPCAN International Congress on Child Abuse and Neglect; Istanbul, Turkey: 2012. Sep 9–12,
    1. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10.
    1. Ioannidis JPA, Patsopoulos NA, Evangelou E. Uncertainty in heterogeneity estimates in meta-analyses. BMJ. 2007;335:914–16.
    1. Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions, version 5. Chichester: The Cochrane Collaboration; 2011.
    1. Ioannidis JPA, Trikalinos TA. An exploratory test for an excess of significant findings. Clin Trials. 2007;4:245–53.
    1. Kavvoura F, McQueen M, Khoury M, Tanzi R, Bertram L, Ioannidis J. Evaluation of the potential excess of statistically significant findings in public genetic association studies: application to Alzheimer’s disease. Am J Epidemiol. 2008;168:855–65.
    1. Inthout J, Ioannidis J, Rovers MM, Goeman J. Plea for routinely presenting prediction intervals in meta-analysis. BMJ Open. 2016;6:e010247.
    1. Ludwig L, Pasman JA, Nicholson T, et al. Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies. Lancet Psychiatry. 2018;5:307–20.
    1. Molendijk ML, Hoek HW, Brewerton TD, Elzinga BM. Childhood maltreatment and eating disorder pathology: a systematic review and dose–response meta-analysis. Psychol Med. 2017;47:1402–16.
    1. Nelson J, Klumparendt A, Doebler P, Ehring T. Childhood maltreatment and characteristics of adult depression: meta-analysis. Br J Psychiatry. 2016;209:96–104.
    1. Neumann DA, Houskamp BM, Pollock VE, Briere J. The long-term sequelae of childhood sexual abuse in women: a meta-analytic review. Child Maltreat. 1996;1:6–16.
    1. Ng QX, Yong BZJ, Ho CYX, Lim DY, Yeo W-S. Early life sexual abuse is associated with increased suicide attempts: an update meta-analysis. J Psychiatr Res. 2018;99:129–41.
    1. Quinones-Munoz SL. Psychological effects of childhood sexual abuse in adult males. Diss Abstr Int Sect B Sci Eng. 2001;62:2074.
    1. Ulrich H, Randolph M, Acheson S. Child sexual abuse: a replication of the meta-analytic examination of child sexual abuse by Rind, Tromovitch, and Bauserman (1998) Sci Rev Ment Health Pract. 2005;4:37–51.
    1. Fossati A, Madeddu F, Maffei C. Borderline personality disorder and childhood sexual abuse: a meta-analytic study. J Pers Disord. 1999;13:268–80.
    1. Halpern SC, Schuch FB, Scherer JN, et al. Child maltreatment and illicit substance abuse: a systematic review and meta-analysis of longitudinal studies. Child Abuse Rev. 2018;27:344–60.
    1. Hauser W, Kosseva M, Uceyler N, Klose P, Sommer C. Emotional, physical, and sexual abuse in fibromyalgia syndrome: a systematic review with meta-analysis. Arthritis Care Res. 2011;63:808–20.
    1. Irish L, Kobayashi I, Delahanty DL. Long-term physical health consequences of childhood sexual abuse: a meta-analytic review. J Pediatr Psychol. 2010;35:450–61.
    1. Klonsky E, Moyer A. Childhood sexual abuse and non-suicidal self-injury: meta analysis. Br J Psychiatry. 2008;192:166–70.
    1. Chen H, Cohen P, Chen S. How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Commun Stat Simul Comput. 2010;39:860–64.
    1. Silverman AB, Reinherz HZ, Giaconia RM. The long-term sequelae of child and adolescent abuse: a longitudinal community study. Child Abuse Negl. 1996;20:709–23.
    1. Dube SR, Anda RF, Felitti VJ, Chapman DP, Giles WH. Childhood abuse, neglect and household dysfunction and the risk of illicit drug use: the Adverse Childhood Experience Study. Pediatrics. 2003;111:564–72.
    1. Nemeroff CB, Binder E. The preeminent role of childhood abuse and neglect in vulnerability to major psychiatric disorders: toward elucidating the underlying neurobiological mechanisms. J Am Acad Child Adolesc Psychiatry. 2018;53:395–97.
    1. Danese A, Baldwin JR. Hidden wounds? Inflammatory links between childhood trauma and psychopathology. Annu Rev Psychol. 2017;68:517–44.
    1. Kilimnik CD, Meston CM. Role of body esteem in the sexual excitation and inhibition responses of women with and without a history of childhood sexual abuse. J Sex Med. 2016;13:1718–28.
    1. Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009;373:68–81.
    1. Homma Y, Wang N, Saewyc E, Kishor N. The relationship between sexual abuse and risky sexual behavior among adolescent boys: a meta-analysis. J Adolesc Health. 2012;51:18–24.
    1. Tiruneh K, Wasie B, Gonzalez H. Sexual behavior and vulnerability to HIV infection among seasonal migrant laborers in Metema district, northwest Ethiopia: a cross-sectional study. BMC Public Health. 2015;15:122.
    1. Nanni V, Uher R, Danese A. Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. Am J Psychiatry. 2012;169:141–51.
    1. Luppino F, de Wit L, Bouvy P, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67:220–29.
    1. Stunkard AJ, Faith MS, Allison KC. Depression and obesity. Biol Psychiatry. 2018;54:330–37.
    1. de Zwaan M. Binge eating disorder and obesity. Int J Obes Relat Metab Disord. 2001;25(suppl 1):S51–55.
    1. Hudson J, Lalonde J, Berry J, et al. Binge-eating disorder as a distinct familial phenotype in obese individuals. Arch Gen Psychiatry. 2006;63:313–19.
    1. Yanovski SZ. Binge eating disorder and obesity in 2003: could treating an eating disorder have a positive effect on the obesity epidemic? Int J Eat Disord. 2003;34:S117–20.
    1. Agnew-Blais J, Danese A. Childhood maltreatment and unfavourable clinical outcomes in bipolar disorder: a systematic review and meta-analysis. Lancet Psychiatry. 2016;3:342–49.
    1. Walsh K, Zwi K, Woolfenden S, Shlonsky A. School-based education programs for the prevention of child sexual abuse: a Cochrane systematic review and meta-analysis. Res Soc Work Pract. 2018;28:33–55.
    1. Mikton C, Butchart A. Child maltreatment prevention: a systematic review of reviews. Bull World Health Organ. 2009;87:353–61.
    1. Chen M, Chan KL. Effects of parenting programs on child maltreatment prevention: a meta-analysis. Trauma Violence Abuse. 2016;17:88–104.
    1. Liel C. Parenting programs for mothers who are at risk or indicated for child abuse and neglect—a systematic review of the international research literature. Psychol Erziehung und Unterr. 2013;60:11–25.
    1. Euser S, Alink LRA, Stoltenborgh M, Bakermans-Kranenburg MJ, van Ijzendoorn MH. A gloomy picture: a meta-analysis of randomized controlled trials reveals disappointing effectiveness of programs aiming at preventing child maltreatment. BMC Public Health. 2015;15:1068.
    1. Kellogg N. The evaluation of sexual abuse in children. Pediatrics. 2005;116:506–12.
    1. Ehring T, Welboren R, Morina N, Wicherts JM, Freitag J, Emmelkamp PMG. Meta-analysis of psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clin Psychol Rev. 2014;34:645–57.
    1. Trask EV, Walsh K, DiLillo D. Treatment effects for common outcomes of child sexual abuse: a current meta-analysis. Aggress Violent Behav. 2011;16:6–19.
    1. Ramchandani P, Jones DPH. Treating psychological symptoms in sexually abused children: from research findings to service provision. Br J Psychiatry. 2003;183:484–90.
    1. Benuto LT. Trauma-focused cognitive behavioral therapy for juvenile victims of sexual abuse. In: Daniel S, Bromberg DS, O’Donohue WT, editors. Toolkit for working with juvenile sex offenders. San Diego, CA: Academic Press; 2014. pp. 291–312.
    1. Rull J, Pereda N. Psychological intervention with adults sexually abused as children: a systematic review. Anu Psicol. 2011;41:81–105.
    1. Macdonald G, Higgins JP, Ramchandani P, et al. Cognitive-behavioural interventions for children who have been sexually abused. Cochrane Database Syst Rev. 2012;16 CD001930.
    1. Afifi TO, MacMillan HL. Resilience following child maltreatment: a review of protective factors. Can J Psychiatry. 2011;56:266–72.
    1. Domhardt M, Munzer A, Fegert JM, Goldbeck L. Resilience in survivors of child sexual abuse: a systematic review of the literature. Trauma Violence Abuse. 2015;16:476–93.
    1. Noll JG, Zeller MH, Trickett PK, Putnam FW. Obesity risk for female victims of childhood sexual abuse: a prospective study. Pediatrics. 2007;120:e61–67.
    1. Elklit A, Shevlin M. Female sexual victimization predicts psychosis: a case-control study based on the Danish registry system. Schizophr Bull. 2010;37:1305–10.
    1. Spataro J, Mullen PE, Burgess PM, Wells DL, Moss SA. Impact of child sexual abuse on mental health: prospective study in males and females. Br J Psychiatry. 2004;184:416–21.
    1. Fazel S, Smith EN, Chang Z, Geddes JR. Risk factors for interpersonal violence: an umbrella review of meta-analyses. Br J Psychiatry. 2018;213:609–14.
    1. Fitton L, Yu R, Fazel S. Childhood maltreatment and violent outcomes: a systematic review and meta-analysis of prospective studies. Trauma Violence Abuse. 2018 doi: 10.1177/1524838018795269. published online Aug 20.
    1. Lereya ST, Copeland WE, Costello EJ, Wolke D. Adult mental health consequences of peer bullying and maltreatment in childhood: two cohorts in two countries. Lancet Psychiatry. 2015;2:524–31.

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