This paper, published on the Lancet Regional Health - Western Pacific, examines the outcomes of child sexual abuse by perpetrator type and severity.

Summary

Background

The influence of child sexual abuse (CSA) severity and perpetrator type on health problems in adulthood is poorly understood. We examined health outcomes associated with CSA according to severity, number of perpetrators, and perpetrator type.

Methods

We analysed data from a nationally representative sample of 8503 participants. We assessed the influence of four levels of severity and eight types of perpetrators on mental disorders, health risk behaviours, and physical conditions, using multivariable models adjusted for confounders including other maltreatment.

Findings

CSA was strongly associated with several mental disorders, health risk behaviours, and physical conditions. Forced intercourse presented highest odds of health problems compared to no CSA (e.g., cannabis dependence aOR 2.2, 95% CI 1.1–4.5; non-suicidal self-injury aOR 1.7, 1.2–2.5), and compared to other CSA types. CSA by multiple perpetrator types increased adverse outcomes, including non-suicidal self-injury (aOR 4.1, 3.0–5.5), and suicide attempt (aOR 3.8, 2.8–5.1). CSA by both adolescent and adult perpetrators was associated with the greatest risk for outcomes including non-suicidal self-injury (aOR 4.4, 3.0–6.4) and suicide attempt (aOR 3.4, 2.4–4.9) with equivalent adverse outcomes for individuals abused by adolescents only, and adults only. CSA by known adolescents, known adults, and unknown adults, elevated risk of health outcomes.

Interpretation

Greater CSA severity and multiple perpetrator exposure elevates risk of health problems in adulthood. Both known and unknown perpetrators, and adult and adolescent perpetrators, increase risk. Results can inform clinical practice and policy in diverse sectors.