ORIGINAL ARTICLE
Sexual Abuse and Lifetime Diagnosis of Psychiatric Disorders: Systematic Review and Meta-analysis

https://doi.org/10.4065/mcp.2009.0583Get rights and content

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 I2 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.

Section snippets

Data Sources and Searches

The protocol for this systematic review was developed by physicians and researchers in internal medicine, preventive medicine, epidemiology, statistics, and psychology. Methods described by the Cochrane Collaboration were used in the development of the protocol.21 The reporting of results was based on the recommendations of the Meta-analysis of Observational Studies in Epidemiology group.22

We performed a comprehensive search (from January 1980-December 2008, all age groups, any language, any

Study Characteristics

This systematic review yielded 37 studies, 17 case-control and 20 cohort, with 3,162,318 participants (Figure 1).7, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64 Twenty-seven studies assessed childhood abuse, one study assessed adult abuse, and 2 studies assessed adult and childhood abuse separately. The remaining 7 studies did not stratify or report the age at which abuse occurred. Sixteen studies

DISCUSSION

This comprehensive systematic review and meta-analysis of 37 longitudinal observational comparative studies including 3,162,318 participants found an association between a history of sexual abuse and a lifetime diagnosis of anxiety, depression, eating disorders, PTSD, sleep disorders, and suicide attempts. There was no statistically significant association between a history of sexual abuse and a lifetime diagnosis of schizophrenia or somatoform disorders. Association between sexual abuse and

CONCLUSION

Survivors of sexual abuse are commonly encountered in general medical practice. It is now known that sexual abuse survivors face a challenging spectrum of physical and mental health concerns, with associated higher health care use and greater medical expenditures. This systematic review and meta-analysis demonstrates that sexual abuse is associated with multiple psychiatric disorders, including lifetime diagnosis of anxiety disorders, depression, eating disorders, PTSD, sleep disorders, and

Acknowledgments

We are grateful to the Mayo Clinic librarians for their indispensable assistance in the search strategy and review process. We also thank the investigators who were kind enough to forward their unpublished data to us.

REFERENCES (102)

  • J Brown et al.

    Childhood abuse and neglect: specificity of effects on adolescent and young adult depression and suicidality

    J Am Acad Child Adolesc Psychiatry

    (1999)
  • A Buist et al.

    Childhood sexual abuse, parenting and postpartum depression-a 3-year follow-up study

    Child Abuse Negl

    (2001)
  • DM Fergusson et al.

    Exposure to childhood sexual and physical abuse and adjustment in early adulthood

    Child Abuse Negl

    (2008)
  • EF Figueroa et al.

    History of childhood sexual abuse and general psychopathology

    Compr Psychiatry

    (1997)
  • E Frank et al.

    Psychiatric disorders in rape victims: past history and current symptomatology

    Compr Psychiatry

    (1987)
  • A Plunkett et al.

    Suicide risk following child sexual abuse

    Ambul Pediatr

    (2001)
  • ME Rimsza et al.

    Sexual abuse: somatic and emotional reactions

    Child Abuse Negl

    (1988)
  • GW Stuart et al.

    Early family experiences of women with bulimia and depression

    Arch Psychiatr Nurs

    (1990)
  • SL Welch et al.

    Childhood sexual and physical abuse as risk factors for the development of bulimia nervosa: a community-based case control study

    Child Abuse Negl

    (1996)
  • LA Wise et al.

    Adult onset of major depressive disorder in relation to early life violent victimisation: a case-control study

    Lancet

    (2001)
  • ND Kellogg et al.

    Violence among family members of children and adolescents evaluated for sexual abuse

    Child Abuse Negl

    (2003)
  • J Kaufman et al.

    Brain-derived neurotrophic factor-5-HTTLPR gene interactions and environmental modifiers of depression in children

    Biol Psychiatry

    (2006)
  • B Tang et al.

    The influence of child abuse on the pattern of expenditures in women's adult health service utilization in Ontario, Canada

    Soc Sci Med

    (2006)
  • PA Hulme

    Symptomatology and health care utilization of women primary care patients who experienced childhood sexual abuse

    Child Abuse Negl

    (2000)
  • HM Finestone et al.

    Chronic pain and health care utilization in women with a history of childhood sexual abuse

    Child Abuse Negl

    (2000)
  • S Plichta

    The effects of woman abuse on health care utilization and health status: a literature review

    Womens Health Issues

    (1992)
  • MR Kessler et al.

    Group treatments for women sexually abused as children: a review of the literature and recommendations for future outcome research

    Child Abuse Negl

    (2003)
  • M Kreidler

    Group therapy for survivors of childhood sexual abuse who have chronic mental illness

    Arch Psychiatr Nurs

    (2005)
  • RG Bradley et al.

    Utilizing disclosure in the treatment of the sequelae of childhood sexual abuse: a theoretical and empirical review

    Clin Psychol Rev

    (2001)
  • BE Molnar et al.

    Psychopathology, childhood sexual abuse and other childhood adversities: relative links to subsequent suicidal behaviour in the US

    Psychol Med

    (2001)
  • SE Romans et al.

    Child sexual abuse and later disordered eating: a New Zealand epidemiological study

    Int J Eat Disord

    (2001)
  • AL Coker et al.

    Social support protects against the negative effects of partner violence on mental health

    J Womens Health Gend Based Med

    (2002)
  • OR Haavet et al.

    Illness and exposure to negative life experiences in adolescence: Two sides of the same coin? a study of 15-year-olds in Oslo, Norway

    Acta Paediatr

    (2004)
  • MS Yang et al.

    Intimate partner violence and minor psychiatric morbidity of aboriginal Taiwanese women

    Public Health Rep

    (2006)
  • M Cheasty et al.

    Relation between sexual abuse in childhood and adult depression: case-control study

    BMJ

    (1998)
  • J Coid et al.

    Abusive experiences and psychiatric morbidity in women primary care attenders

    Br J Psychiatry

    (2003)
  • D Mazza et al.

    Physical, sexual and emotional violence against women: a general practice-based prevalence study

    Med J Aust

    (1996)
  • AW Burgess et al.

    Rape trauma syndrome

    Am J Psychiatry

    (1974)
  • EO Paolucci et al.

    A meta-analysis of the published research on the effects of child sexual abuse

    J Psychol

    (2001)
  • L Smolak et al.

    A meta-analytic examination of the relationship between child sexual abuse and eating disorders

    Int J Eat Disord

    (2002)
  • M Clark et al.

    Formulating the problem

  • DF Stroup et al.

    Meta-analysis of observational studies in epidemiology: a proposal for reporting: Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group

    JAMA

    (2000)
  • GA Wells et al.

    The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottowa Health Research Institute; L'Institut De Recherche en Sante D'Ottowa Web site

  • JPT Higgins et al.

    Measuring inconsistency in meta-analyses

    BMJ

    (2003)
  • Comprehensive Meta-analysis [computer program]

    (2005)
  • DG Altman et al.

    Interaction revisited: the difference between two estimates

    BMJ

    (2003)
  • A Aglan et al.

    Pathways from adolescent deliberate self-poisoning to early adult outcomes: a six-year follow-up

    J Child Psychol Psychiatry

    (2008)
  • J Brezo et al.

    Predicting suicide attempts in young adults with histories of childhood abuse

    Br J Psychiatry

    (2008)
  • L Brown et al.

    Experiences of physical and sexual abuse in Australian general practice attenders and an eating disordered population

    Aust N Z J Psychiatry

    (1997)
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    1

    Dr Shinozaki is now with the VA Medical Center, Sioux Falls, SD

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