Psychological intervention in women victims of childhood sexual abuse: a randomized controlled clinical trial comparing EMDR psychotherapy and trauma-focused cognitive behavioral therapy.

Introduction: Childhood sexual abuse persists as a painful societal reality, necessitating responses from institutions and healthcare professionals to prevent and address its severe long-term consequences in victims. This study implements an intervention comprising two psychotherapeutic approaches recommended by the WHO and international clinical guidelines for addressing short-, medium-, and long-term posttraumatic symptomatology: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR). Both approaches are adapted from group formats for implementation in small online groups via Zoom. Methods: The impact of both therapeutic approaches on trauma improvement was assessed in a sample of 19 women who were victims of childhood sexual abuse through a Randomized Clinical Trial comparing EMDR Psychotherapy and Trauma-Focused Cognitive Behavioral Therapy after a baseline period. Intra and inter comparison were made using statistics appropriate to the sample. Results: Both therapeutic approaches significantly reduced symptomatology across various evaluated variables, suggesting their efficacy in improving the quality of life for these individuals. Following CBT-FT treatment, patients exhibited enhanced emotional regulation, reduced reexperiencing, and avoidance. The EMDR group, utilizing the G-TEP group protocol, significantly improved dissociation, along with other crucial clinical variables and the perception of quality of life. Discussion: Although the limitations of this study must be taken into account due to the size of the sample and the lack of long-term follow-up, the results align with existing scientific literature, underscoring the benefits of trauma-focused psychological treatments. The online group format appears promising for enhancing the accessibility of psychological treatment for these women. Furthermore, the differential outcomes of each treatment support recent research advocating for the inclusion of both approaches for individuals with trauma-related symptomatology. Ethics and dissemination: The study has been approved by the Ethics Committee of the Valencian International University (VIU) (Valencia, Spain) (Ref. CEID2021_07). The results will be submitted for publication in peer-reviewed journals and disseminated to the scientific community. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04813224, identifier NCT04813224.

Analysis of the Effectiveness of an Affective-Sexual Education Program for Adults with Intellectual Disabilities.

In recent years, the number of programs to improve sex education for people with intellectual disabilities has increased. However, in most cases, these programs do not provide any evidence of their impact. In the present study we analyzed the effectiveness of the SALUDIVERSEX affective-sexual education program for people with intellectual disabilities using a controlled trial design. 246 individuals from eastern Spain completed a battery of questionnaires before and after the intervention. Multilevel statistical analyses showed that the risk of experiencing sexual abuse had significantly decreased and knowledge about sexuality significantly increased among those who received the intervention compared to those who did not. The evaluation of the professionals who worked daily with the participants agreed on how knowledge about sexuality and intimacy increased and concerns about sexuality decreased among those in the intervention group. The SALUDIVERSEX program is a powerful educational strategy to promote better sexual health and quality of life for people with intellectual disabilities.

Sexual Victimization of Adolescents in Residential Care: Self-Reported and Other-Reported Prevalence.

Adolescents in the child welfare system have been exposed to multiple forms of victimization, most notably sexual victimization, many times underreported and misreported. The main aim of this study was to explore the lifetime prevalence of sexual victimization among adolescents in residential care in Eastern Spain, contrasting self-reported information compared to the information reported by the professionals. Sexual abuse/assault characteristics and effects of gender and age were analyzed. Additionally, the association between sexual revictimization and the relationship with the aggressor as well as the age of the first episode of sexual abuse/assault was analyzed. The sample comprised 346 adolescents (34.1% females, 65.9% males) aged between 11 and 19 years old. The prevalence of sexual victimization reported by adolescents was 35.3%, more than double compared to the information reported by professionals (16.9%). Females experienced significantly more sexual victimization than males (OR = 0.23, 95% CI [0.14, 0.37]). The age of the victim at the first episode of sexual abuse/assault and the relationship with the aggressor were explanatory variables of revictimization. Research such as this is crucial to ascertain that these adolescents have very different needs that will influence the design of affective-sexual education initiatives, which are essential to ensure healthy sexual development.

Mental Health of People with Intellectual Disabilities Living in Residential Care before, during, and after Lockdown.

BACKGROUND: The impact of the COVID-19 on the well-being of people with intellectual disabilities (PID) has been little studied. METHODS: We analyzed its impact with a cohort study quantitatively analyzing anxiety, depression, organic symptoms, quality of life, and support needs in 24 PID, aged 19-74 years (x¯ 40, σ = 13.09), living in a residential center, before, during, and after the pandemic. RESULTS: Their mental health improved unexpectedly at the onset of the lockdown although there was an increase in organic symptoms. But, with the progress of the lockdown, their mental health deteriorated drastically. On the contrary, as expected, their quality of life and support needs worsened from the beginning of the lockdown until the country returned to normality, a time when there was a general recovery, without reaching pre-pandemic levels. These results show that the mental health of PID was affected differently to that of people without intellectual disabilities.

People with intellectual disabilities' sexuality from three different perspectives: Parents, professionals, and themselves.

BACKGROUND: A positive conception of sexuality among people with intellectual disabilities is crucial and relies on several social and interpersonal contexts. The goal of this study is to analyse the interaction and impact of three different contextual groups: individuals with intellectual disabilities, their parents, and professionals working with them. METHODS: Survey data were collected from 330 people with intellectual disabilities attending occupational centres in eastern Spain, 330 parents, and 100 professionals. RESULTS: Correlation and variance analyses of dyad-level data show significant differences among the three groups in all variables. Professionals perceived people with intellectual disabilities to have higher knowledge of socio-sexual norms than people with intellectual disabilities actually appear to be, but they are also more concerned about aspects related to this area of people with intellectual disabilities. Compared to people with intellectual disabilities and professionals, parents perceived people with intellectual disabilities to have lower sexual knowledge. CONCLUSIONS: Our study demonstrates inconsistent perceived knowledge of people with intellectual disabilities' socio-sexual norms and sexual knowledge among the three groups, leading to disparate levels of concern regarding people with intellectual disabilities sexuality. Thus, the need to collect information from different perspectives for more accurate reporting and the critical need for sex education programs that involve the target population, but also parents and professionals who frequently interact with people with intellectual disabilities are highlighted.

SALUDIVERSEX: A quality of life and sexual health intervention for adults with mild intellectual disabilities.

Individuals with intellectual disabilities need an affective and sexual education adapted to their characteristics. There are few interventions that meet these objectives and offer empirical evidence of their efficacy. To respond to the limitations of existing interventions, an evidence-based affective-sexual educational intervention for adults with a mild degree of intellectual disability is proposed: SALUDIVERSEX. Participants will be randomly assigned to an intervention group that will receive the SALUDIVERSEX program or to a waiting list group. The intervention will be implemented by educators of occupational centers after a thorough training phase. Our main hypothesis is that the SALUDIVERSEX program will improve the sexual health and quality of life, through the joint action built into three components: the acquisition of basic information, the development of skills and strategies and the achievement of healthy attitudes towards the experience and expression of sexuality. The results of this approach could have important implications for optimizing the quality of life and self-determination of individuals with Intellectual disability by contributing to the development of healthy sexuality.

Construction of a Form for Users of the Child Welfare System Based on the Delphi Method.

Professionals in charge of designing individualized plans for children and adolescents in the child welfare system often lack the necessary information, either because it has not been systematically collected or because there are doubts about the reliability of the data obtained. The lack of consensual and validated instruments that gather the necessary information has led to the development of a rigorous and effective form, based on the Delphi methodology, aimed at obtaining an exhaustive knowledge of the characteristics of children and adolescents under the child welfare system. Once a consensus of different specialists approved the hetero-informed form, it was completed by 41 professionals working in residential care facilities for 307 children and adolescents. It consists of 66 items grouped into six dimensions: general information, school/work situation, child welfare system history, family visitation history, biological family information, and experiences of sexual abuse. During its construction and validation, a panel of experts analyzed its format and content during the different phases. Most of the items showed good performance, and professionals highlighted their ease of use and relevance. The method used ensured the content validity of this form. This instrument has proven to be a useful and effective tool for collecting sociodemographic information on children and adolescents in the child welfare system, which may improve their conditions.

Sexual life of Spanish women during the lockdown by COVID-19: Differences according to sexual orientation?

The COVID-19 pandemic may have exacerbated the sexual health differences that already existed among women based on their sexual orientation. Therefore, a total of 971 Spanish women aged 18-60 years (84 % heterosexual and 16 % with a minority sexual orientation) answered an ad hoc online questionnaire about sexual behavior during April 2020. Compared to heterosexual women, sexual minority women showed a greater increase in sexual frequency, masturbated more, had more sex with a housemate, and engaged in more online sexual activities during lockdown. The emotional impact of the pandemic, having privacy, and age showed a relationship with the quality of sexual life, but not sexual orientation. Based on these results, women's sexual lives are not as closely related to their sexual orientation as they are to other variables. Therefore, it seems more necessary to address issues affecting women in general during lockdown than to focus on their specific sexual orientation.

Analysis of the Differential Efficacy of the Reduced Version Over the Extended Version of an Affective-Sexual Education Program for Adults with Intellectual Disabilities.

Recently, with the increase in demand, multiple intervention proposals aimed at improving the sexual health of people with intellectual disabilities have emerged. Among them is the SALUDIVERSEX program, which takes a positive approach to sexuality. It has an extended version, consisting of 16 sessions and whose efficacy has already been proven, and a reduced version of 10 sessions. Thus, the present study aimed to test the differential efficacy of the two versions. A total of 208 participants (103 women and 105 men) aged between 19 and 67 years (M = 37.23, SD = 10.66) completed a battery of instruments before and after the intervention. Statistical analyses showed that users who participated in the reduced version of the program presented a significantly higher rate of improvement in their sexual behaviors compared to those who participated in the extended version (Sexual response: ß10 = - 0.46 ± 0.19, p = .034; Sex practices: ß10 = - 0.52 ± 0.23, p = .037; Use condoms: ß10 = - 1.56 ± 0.59, p = .017), as well as a significantly higher decrease in the risk of suffering sexual abuse (ß10 = 3.95 ± 0.64, p < .001). However, no statistically significant differences in sexuality knowledge were obtained with respect to the improvement between the two versions (ß10 = - 0.09 ± 1.21, p = .94). Meanwhile, the professionals who applied the program found that those who participated in the reduced version, although they presented a significantly greater increase in their knowledge about privacy (ß10 = - 0.48 ± 0.08, p < .001), did not improve their concerns about their inappropriate sexual behaviors as much as the users of the extended version (ß10 = - 1.35 ± 0.21, p < .001). Thus, although both versions were effective, the reduced version seems to do so to a greater extent and in a shorter time, which makes it the more recommendable option.

Sexual Health among Youth in Residential Care in Spain: Knowledge, Attitudes and Behaviors.

Adolescents in the child welfare system often face multiple maladaptive experiences that predispose them to worse sexual health outcomes. This study aims to (1) describe the sexual health of adolescents in Spanish residential care by exploring their sexual knowledge, attitudes toward sexuality, and sexual behaviors and (2) to find out whether there are certain characteristics that make a subgroup particularly vulnerable to engaging in risky sexual behaviors. A total of 346 adolescents recruited from 47 Spanish residential care facilities (34.1% girls, 65.9% boys) aged between 11 and 19 years old completed some self-report instruments. Descriptive analyses and tests to prove gender and age differences were conducted. Their knowledge of sexuality was lower than observed in the general adolescent population, their attitudes more negative, and their tendency to engage in risky sexual behaviors higher. Girls made very infrequent use of condoms, while boys had more sexist attitudes and made habitual use of withdrawal. Although more than 20% of them had experienced sexual exchange activities before the age of 13 until 17, they did not use condoms systematically. The low level of knowledge, the early initiation of sexual exchange activities, and the scarce use of protection methods, together with sexist attitudes, place this group in a situation of great vulnerability, increasing the risk of unwanted pregnancies, sexually transmitted infections, and even teen dating violence.

Factors associated with condom use in vaginal intercourse among Spanish adults with intellectual disability: Proposal for an explanatory model.

BACKGROUND: The prevention of HIV or other STIs in people with intellectual disabilities (ID) is a rarely studied subject even though this population group is at the same risk of infection as the general population. AIMS: The present study aims to conduct a descriptive analysis of sexual behaviours and condom use frequency in Spanish men and women with intellectual disabilities and identify the combination of variables that best explain condom use in vaginal intercourse. METHODS AND PROCEDURES: The sample consisted of 253 people (56.1 % male and 43.9 % female) aged between 20 and 64 years (M = 38.52; SD = 10.48). Participants completed the Sexuality Questionnaire for People with Intellectual Disabilities and the Sexual Abuse Risk Screening Scale. OUTCOMES AND RESULTS: The percentage of consistent condom use is 27.7 % for vaginal intercourse. Lack of knowledge about body boundaries constitutes a risk factor contributing to risky sexual behaviour. Knowledge of HIV-transmitting fluids and perceived self-efficacy are protective factors. The proposed model explains between 35.5 % and 46.6 % of the variance. CONCLUSIONS AND IMPLICATIONS: The results highlight the importance of considering the judgements people make about their ability to perform preventive behaviour and the provision of information on sexuality adapted to cognitive abilities to minimise the engagement in risky behaviours.

Development and psychometric properties of an instrument for the Assessment of Sexual Behaviour and Knowledge of people with Intellectual Disability.

BACKGROUND: This paper presents psychometric properties of an instrument for the Assessment of Sexual Behaviour and Knowledge of people with Intellectual Disability (ASBKID), other-reported by professionals who are in daily contact with them. METHODS AND PROCEDURES: Assessments of 236 individuals with intellectual disability were obtained from 100 professionals. RESULTS: Confirmatory factor analysis revealed a four-factor structure: concern about the user's inappropriate or uninhibited sexual behaviour; perception of the user's knowledge about privacy and social norms; perception of the user's knowledge about sexuality; and concerns about the user's sexuality. A multi-group CFA was also conducted in men and women, confirming the adequacy of this four-factor structure by gender. The reliability of the factors ranged from 0.74 to 0.92. CONCLUSIONS: The psychometric results obtained support the use of the ASBKID as a valid and reliable measure for the assessment of sexual behaviour and knowledge in both men and women with intellectual disability.

Development and psychometric properties of a self-report instrument for the assessment of sexual behaviour and concerns of people with mild intellectual disabilities (SEBECOMID-S).

BACKGROUND: This paper presents a description of the development and psychometric properties of a self-report instrument for the assessment of sexual behaviour and concerns of people with mild intellectual disabilities (SEBECOMID-S). METHODS AND PROCEDURES: The study included 281 people with mild intellectual disabilities. The psychometric properties were examined through exploratory factorial analysis, descriptive statistics, and reliability indices. RESULTS: The exploratory factor analyses offered a structure with three factors: concern about the appropriateness of their sexual behaviour, sexual practices performed, and safe sex practices. The model presents an excellent fit (χ2 /df = 1.10, RMSEA = 0.019, CFI = 0.997, TLI = 0.995, and SRMR = 0.065). General test reliability was good (α = 0.77, Ω = 0.76). CONCLUSIONS: SEBECOMID-S is a valid and reliable tool to obtain objective information about the sexual behaviour and concerns of people with mild intellectual disabilities. The use of this instrument will make it possible to adjust their training to their real experiences, making it more effective.

Estimating sexual knowledge of people with mild intellectual disability through a valid and reliable assessment scale: The ISK-ID.

BACKGROUND: Despite the relevance of assessing sexual knowledge in people with Intellectual Disability, there is a lack of appropriate assessment tools to measure this domain. The current study tests the psychometric properties of the new 'Inventory of Sexual Knowledge of people with Intellectual Disability' (ISK-ID). METHOD: 345 individuals with mild intellectual disability completed the ISK-ID before and after the implementation of a sexual education program. Psychometric properties of the ISK-ID were analysed according to Multidimensional Item Response Theory (MIRT). RESULTS: Its underlying factorial structure, along with parameters derived from the MIRT (item discrimination, difficulty, and participant's ability), support the use of the ISK-ID as a measure of sexual knowledge. Moreover, the ISK-ID was able to detect changes in the level of sexual knowledge resulting from educational interventions (i.e., responsiveness). CONCLUSIONS: The ISK-ID is an appropriate assessment tool to measure sexual knowledge in men and women with mild intellectual disability.

Academic Perfectionism, Psychological Well-Being, and Suicidal Ideation in College Students.

High levels of perfectionism in college students can compromise their academic performance and psychological well-being. This study aims to analyze the implication of perfectionism in psychological well-being and suicidal ideation in the last year. A total of 1.287 students from different degrees reported their academic performance in the previous academic year and completed questionnaires on academic perfectionism, psychological well-being, and suicidal thoughts in the last year. In both men and women, academic perfectionism correlates positively with academic performance and negatively with the different dimensions of psychological well-being. Likewise, both the average grade in the previous year (ß = 0.364) and the level of demand of the degree (ß = -0.461) are mediating variables between perfectionism and psychological well-being. Furthermore, the interaction between perfectionism and academic performance is related positively to psychological well-being, but not to with suicidal ideation. So, the relation between suicidal ideation and perfectionism is positive (OR = 1.075), but this is negative with academic performance (OR = 0.900), although both variables show a mild predictive capacity. These findings suggest that the levels of perfectionism are associated differently with the mental health of students, since if perfectionism is effective (high academic performance), psychological well-being is high, although in our results, this interaction is not as important for suicidal thoughts.