Schizophrenia and other psychotic disorders in a cohort of sexually abused children.

CONTEXT: The evidence for an association between child sexual abuse and subsequently developing psychotic disorders, including the schizophrenias, remains inconclusive. OBJECTIVE: To explore whether child sexual abuse is a risk factor for later psychotic disorders. DESIGN: Case-control study. SETTING: Sample drawn from all notified cases of child sexual abuse over a 30-year period in Victoria, Australia. PARTICIPANTS: A cohort of 2759 individuals ascertained as having been sexually abused when younger than 16 years had their subsequent contacts with mental health services established by data linkage. They were compared with a community-based control group matched on sex and age groupings whose rates of disorder were established using identical methods. MAIN OUTCOME MEASURES: Rates of psychotic and schizophrenic illnesses. RESULTS: Rates were significantly higher among child sexual abuse subjects compared with controls for psychosis in general (2.8% vs 1.4%; odds ratio, 2.1; 95% confidence interval, 1.4-3.1; P < .001) and schizophrenic disorders in particular (1.9% vs 0.7%; odds ratio, 2.6; 95% confidence interval, 1.6-4.4; P < .001). Those exposed to penetrative abuse had even higher rates of psychosis (3.4%) and schizophrenia (2.4%). Abuse without penetration was not associated with significant increases in psychosis or schizophrenia. The risks were highest for those whose abuse involved penetration, occurred after age 12 years, and involved more than 1 perpetrator, the combination producing rates of 8.6% for schizophrenia and 17.2% for psychosis. CONCLUSIONS: Child sexual abuse involving penetration is a risk factor for developing psychotic and schizophrenic syndromes. The risk is greater for adolescents subjected to penetration. Irrespective of whether this statistical association reflects any causal link, it does identify an at-risk population in need of ongoing support and treatment.

Psychopathology in a large cohort of sexually abused children followed up to 43 years.

OBJECTIVE: To determine the rate and risk of clinical and personality disorders diagnosed in childhood and adulthood in those known to have been sexually abused during childhood. METHODS: Forensic medical records of 2,759 sexually abused children assessed between 1964 and 1995 were linked with a public psychiatric database between 12 and 43 years later. Cases were compared to control subjects matched on gender and age groupings drawn from the general population through a random sample of the national electoral database. RESULTS: A lifetime record of contact with public mental health services was found in 23.3% of cases compared to 7.7% of controls. The rate of contact among child sexual abuse victims was 3.65 times higher (95% CI, 3.09-4.32, p<0.001). It was estimated that child sexual abuse accounted for approximately 7.83% of mental health contact. Exposure to sexual abuse increased risks for the majority of outcomes including psychosis, affective, anxiety, substance abuse, and personality disorders. Rates of clinical disorders diagnosed in adulthood and childhood remained significantly higher among child sexual abuse cases. Older age at sexual abuse and those exposed to severe abuse involving penetration or multiple offenders were associated with greater risk for psychopathology. CONCLUSIONS: This study confirms that child sexual abuse is a substantial risk factor for a range of mental disorders in both childhood and adulthood. PRACTICE IMPLICATIONS: Those treating victims of sexual abuse must assess not only disorders commonly associated with trauma, but also low prevalence disorders such as psychosis.

Suicide and fatal drug overdose in child sexual abuse victims: a historical cohort study.

OBJECTIVE: To determine the rate and risk of suicide and accidental fatal drug overdose (ie, overdose deemed not to have been suicide) in individuals who had been medically ascertained as having been sexually abused during childhood. DESIGN: A historical cohort linkage study of suicide and accidental drug-induced death among victims of child sexual abuse (CSA). SETTING AND PATIENTS: Forensic medical records of 2759 victims of CSA who were assessed between 1964 and 1995 were obtained from the Victorian Institute of Forensic Medicine and linked with coronial data representing a follow-up period of up to 44 years. MAIN OUTCOME MEASURES: Rates of suicide and accidental fatal drug overdose recorded in coronial databases between 1991 and 2008, and rates of psychiatric disorders and substance use recorded in public mental health databases. RESULTS: Twenty-one cases of fatal self-harm were recorded. Relative risks for suicide and accidental fatal overdose among CSA victims, compared with age-limited national data for the general population, were 18.09 (95% CI, 10.96-29.85; population-attributable risk, 0.37%), and 49.22 (95% CI, 36.11-67.09; population-attributable risk, 0.01%) respectively. Relative risks were higher for female victims. Similar to the general population, CSA victims who died as a result of self-harm were predominantly aged in their 30s at time of death. Most had contact with the public mental health system and half were recorded as being diagnosed with an anxiety disorder. CONCLUSION: Our data highlight that CSA victims are at increased risk of suicide and accidental fatal drug overdose. CSA is a risk factor that mediates suicide and fatal overdose.