Police-reported family violence victimisation or perpetration and mental health-related emergency department presentations: an Australian data-linkage study.

BACKGROUND: Family violence is a leading social determinant of mental ill-health but its link to mental health-related emergency department presentations is poorly understood. Existing research has largely used retrospective designs with a focus on victimisation, typically among women. We examined whether police-reported family violence victimisation and perpetration were prospectively associated with mental health emergency department presentations in women and men. We also identified family violence risk and vulnerability characteristics associated with such presentations. METHODS: Demographics, prior police involvement, and individual and relationship vulnerabilities were provided by Victoria Police for 1520 affected family members (i.e., primary victims) and 1470 respondents (i.e., persons alleged to have perpetrated family violence) from family violence reports in 2016-17. Emergency mental health presentations 22-30 months post-family-violence report were determined through linkage with the Victorian Emergency Minimum Dataset and compared to statewide presentations. RESULTS: Emergency mental health presentations during follow-up were identified in 14.3% of the family violence sample, with 1.9% presenting for self-harm. Mental health presentation rates per 1,000 people were markedly higher among affected family members and respondents of both sexes and all ages than in the general population, except for male affected family members aged 45 + . Adjusting for age and sex, the mental health presentation rate was 6 and 11 times higher among affected family members and respondents, respectively, than in the general population. Individual vulnerabilities were more closely related to risk of emergency mental health presentations than relationship characteristics. CONCLUSIONS: Police-recorded family violence is associated with increased mental health-related emergency department presentations over the short-to-medium term. Strengthened cross-sector collaboration is needed to identify, address, and refer individuals with overlapping family violence and mental health needs and to improve victims' and perpetrators' access to community mental health and related services. This should help prevent individuals from reaching a crisis point in their mental health.

Sexual abuse during childhood and all-cause mortality into middle adulthood: an Australian cohort study.

OBJECTIVE: To compare mortality from all causes, internal causes (eg, cancers, circulatory and respiratory system diseases), and external causes (eg, suicide, accidents, assault) among people who were sexually abused during childhood with mortality for the general population. DESIGN: Historical cohort study. SETTING, PARTICIPANTS: 2759 people (2201 women, 79.8%) who had experienced medically assessed contact sexual abuse in Victoria while aged 16 years or younger during 1964-1995, as recorded in Victorian Institute of Forensic Medicine records. MAIN OUTCOME MEASURES: Mortality rate, based on linked National Death Index data (1980-2020), by five-year age group; sex- and age-standardised mortality ratios; comparison of rates with age- and sex-adjusted rates for the general Victorian population (incident rate ratio [IRR]). RESULTS: We included 115 deaths of people under 50 years of age in our analysis (4.2% of people sexually abused as children; 79 women, 36 men); 56 deaths were attributed to external, 56 to internal causes (cause of death information missing in three cases). In each age group from 15-19 years, the mortality rates for people sexually abused as children were higher than for the general population; age- and sex-standardised all-cause mortality ratios were highest for people aged 25-29 years (men: 16.5; 95% confidence interval [CI], 11.0-22.0; women: 19.2; 95% CI, 14.3-24.2). The age- and sex-adjusted mortality rate for people sexually abused as children was higher than in the general population for all-cause (IRR, 8.25; 95% CI, 5.92-11.5), internal cause (IRR, 5.92; 95% CI, 3.89-9.01), and external cause deaths (IRR, 12.6; 95% CI, 9.61-16.6); the differences in external cause mortality were greater for people who had experienced penetrative (IRR, 14.9; 95% CI, 10.9-20.5) than for those who had experienced non-penetrative sexual abuse as children (IRR, 8.92; 95% CI, 5.35-14.9). CONCLUSIONS: Sexual abuse during childhood is associated with higher mortality rates into mid-adulthood. Preventing child sexual abuse and intervening early to reduce the damage it inflicts is not only essential for the welfare of the child, but could also help reduce avoidable deaths later in life.

The Role of Situational Factors in Child-to-Parent Abuse: Implications for Assessment, Management, and Intervention.

Situational factors are relevant to the initiation and maintenance of violent behavior yet are infrequently examined in relation to family violence. Content analysis was used to conduct an inductive thematic analysis of police narratives to identify and quantify the occurrence of situational factors among Australian young people (10-24 years) reported to police for using violence toward a parent (n = 82). Descriptive information about demographics (e.g., age and sex), background characteristics (e.g., victimization history, employment/school issues, mental health issues, and neurodevelopmental conditions), and features of the index incident (e.g., type of aggression) were also extracted from police records. Interpersonal conflict and parental limit-setting were the most common situational antecedents of child-to-parent abuse, with additional situational factors including use of weapons, role of third parties, mental health concerns, and substance abuse issues. Families experiencing child-to-parent abuse showed heightened levels of intrafamilial violence and neurodevelopmental conditions. Implications for risk assessment, management, and intervention are discussed.

Do insecure adult attachment styles mediate the relationship between childhood maltreatment and violent behavior?

Attachment theory has played an important role in attempts to understand the "cycle of violence," where maltreated children are at increased risk for perpetrating violence later in life. However, little is known empirically about whether adult attachment insecurity in close relationships may partly explain the link between childhood maltreatment and violent behavior. This study aimed to address this gap using data from a prospective longitudinal study of documented childhood abuse and neglect cases and demographically matched controls (ages 0-11 years), who were followed into adulthood and interviewed (N = 892). Participants completed the Relationship Scales Questionnaire assessing adult attachment styles at mean age 39.54. Criminal arrest data were used to determine arrests for violence after the assessment of attachment through mean age 50.54. There were significant direct paths from childhood maltreatment and adult attachment insecurity to violent arrests after attachment measurement. Attachment insecurity partly explained the higher levels of violence in individuals with maltreatment histories. Analyses of maltreatment subtypes and attachment styles revealed that attachment anxiety appeared to mediate paths between neglect and physical abuse and later violence. There were no significant indirect paths from neglect or physical abuse to violence via attachment avoidance. Implications and future directions are discussed.

Gender Differences in the Maltreatment-Youth Offending Relationship: A Scoping Review.

Maltreated and child welfare-involved youth are over-represented in juvenile justice systems. These youth are at a greater risk of serious offending and justice system entrenchment relative to their non-maltreated peers. Understanding gender differences in the pathways to justice involvement and the nature of offending among maltreated children is critical for informing policy and practice. Yet, this body of evidence is fragmented. This scoping review identified and narratively synthesized evidence from studies reporting on gender differences in the individual characteristics, maltreatment experiences, child protection involvement and offending profiles of maltreated youth who offend. A comprehensive search of four databases generated 11,568 publications, from which 180 met the review's inclusion criteria. These primary studies included participants aged 8-21 years with a history of childhood maltreatment and youth offending and reported at least one gendered analysis. Some consistent findings were reported across studies. A greater level of child welfare involvement and maltreatment exposure (particularly sexual abuse and multi-type maltreatment) was found for justice involved girls, relative to boys. Maltreated and child welfare-involved boys appear more likely to offend than girls, but findings about how gender moderates the maltreatment-offending relationship were inconsistent. Child welfare systems involvement (particularly foster care and residential care) appeared to be an important moderator for girls, and school performance mediated outcomes for boys. Across this body of evidence, few studies accounted for under-reporting of abuse and neglect when using youth self-report measures of maltreatment. Future research is needed which explicitly explores how gender moderates the maltreatment-offending relationship.

Clients' current presentation yields best prediction of criminal recidivism: Jointly modeling repeated assessments of risk and recidivism outcomes in a community sample of paroled New Zealanders.

OBJECTIVE: Clinicians often rely on readily observable intermediate outcomes (e.g., symptoms) to assess the likelihood of events that occur outside of treatment (e.g., relapse). Similarly, those monitoring clients with histories of criminal involvement attempt to prevent adverse outcomes considered likely and intervene when symptoms/risk factors fluctuate. Our aim was to develop a stronger understanding of associations between evolving symptoms/risk factors and case outcomes, yielding clearer practice implications. METHOD: We used longitudinal, multiple reassessment risk data from 3,421 individuals paroled in New Zealand. We used joint modeling to test the association between individual trajectories of psychosocial risk factor scores, assessed using Dynamic Risk Assessment for Offender Re-entry, and recidivism (official records of parole violations or criminal charges resulting in reconviction). We examined whether recent clinically relevant features of risk presentation (e.g., current levels, recent rate of change) predicted recidivism better than the entirety of the risk assessment trajectory. RESULTS: Although each model demonstrated similar predictive validity, measures of model fit indicated that models using current trajectory features outperformed those using the entire assessment history to predict recidivism. CONCLUSIONS: Change in dynamic risk factors is consistently associated with recidivism outcomes. When using changeable factors to monitor clients' current risk for recidivism, practitioners should focus on current presentation rather than the entire assessment history, although differences in predictive discrimination are small. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Determinants and Outcomes of the Therapeutic Alliance in Treating Justice-Involved Youth: A Systematic Review of Quantitative and Qualitative Research.

A large body of research supports the role of the therapeutic alliance in predicting positive change in psychotherapy. This systematic review examined determinants of alliance quality and its association with treatment outcomes in an under-served and under-researched population-justice-involved youth-with whom several challenges and contextual considerations arise that bear relevance to the alliance. The search strategy yielded 23 independent studies meeting eligibility criteria and describing diverse treatments: 14 quantitative records synthesized narratively and nine qualitative studies that underwent thematic analysis. A complex picture emerged, precluding firm conclusions about factors linked to enhanced alliances and the alliance-outcome relationship with justice-involved youth. Nevertheless, some promising findings were noted across quantitative studies, including potential treatment benefits related to alliance growth and creating positive alliances with caregivers. The review also highlighted the potential relevance of the young person's relationships with peers and parents and their treatment readiness and expectations to alliance quality. Drawing on adolescent, caregiver, and therapist perspectives, the thematic synthesis of qualitative studies generated themes related to key elements of constructive alliances and their role in creating a foundation for initiating change. An integrated discussion is provided, highlighting practical implications and suggestions for addressing methodological limitations and substantive knowledge gaps.

Patterns of Maltreatment Co-Occurrence in Incarcerated Youth in Australia.

Child maltreatment research is increasingly recognizing the need to capture patterns of co-occurrence between different types of abuse/neglect and to consider their associations with psychosocial functioning. Few studies have examined these issues in justice-involved youth despite the fact that rates of maltreatment and trauma-related psychopathology are disproportionately high among this population. This study examined profiles of self-reported child physical abuse, sexual abuse, emotional abuse, and neglect among incarcerated juveniles in Victoria, Australia, using latent class analysis. We also investigated associations between maltreatment profiles and mental health and behavioral problems. Data pertaining to juveniles' experiences of maltreatment and mental health and behavioral functioning were collected from interviews, questionnaires, files, and administrative datasets. A three-class solution provided the best fit for the data and was conceptually meaningful: a "low/rare maltreatment" class (41%); "high physical and emotional abuse" class (23%); and a "poly-victimization" class (36%). Youth in the "poly-victimization" class experienced especially serious mental health and behavioral disturbances, including higher rates of mental illness, greater severity of internalizing and externalizing symptoms, impulsivity, substance abuse, self-harm and suicidal behavior, irritability, and early-onset violence. Results suggest there may be benefit in considering screening and assessment procedures in youth justice settings to identify poly-victimized youth in need of more intensive monitoring and treatment to address their complex clinical and behavioral profiles.

Child Sexual Abuse and Risk of Revictimization: Impact of Child Demographics, Sexual Abuse Characteristics, and Psychiatric Disorders.

Approximately half of child sexual abuse (CSA) victims report sexual revictimization later in life; however, there is limited rigorous evidence concerning factors contributing to sexual and nonsexual forms of revictimization. This article investigates the relationships between CSA and a range of revictimization experiences. It also examines the role of other individual-level factors (demographics, CSA characteristics, psychiatric disorders) in the risk of revictimization. The study compares data from a prospective-longitudinal study of 2,759 Australian children (<17 years old) alleged to have experienced contact-CSA between 1964 and 1995, and a comparison group matched on sex and age. In each case, CSA was deemed likely to have occurred according to expert forensic medical opinion. Abused children and comparisons were followed to age 35 years on average, and their lifetime official crime victimization histories and public mental health service records were extracted from statewide population-level administrative databases. Relative to comparisons, CSA victims experienced significantly higher rates of revictimization, with marked elevations in odds for interpersonal revictimization (i.e., sexual assault, physical assault, threats of violence, and stalking). The CSA-physical assault relationship was moderated by sex, with a stronger association for female victims. Among CSA victims, victim sex, age at index abuse, and several psychiatric diagnostic categories were independently associated with revictimization risk, with different patterns of vulnerability emerging depending on the nature of revictimization. Overall, CSA victims are vulnerable to a range of revictimization experiences later in life. Findings have implications for the identification of particular groups of sexually abused children at heightened risk for revictimization and the role mental health services may play in mitigating risk.

Long-term healthcare utilisation following child sex abuse: A follow-up study utilising five years of medical data.

BACKGROUND: Limited attention has been paid to the long-term physical health consequences experienced by CSA survivors. Research has found that CSA is often associated with increased health burden in adulthood. However, research in this area is plagued by a range of methodological difficulties, rendering it difficult to draw conclusions regarding the health status of CSA survivors. OBJECTIVE: This research sought to investigate associations between child sexual abuse (CSA) victimisation and rates of subsequent healthcare utilisation. METHOD: The forensic medical records of 2759 cases of CSA between 1964 and 1995 were linked to commonwealth Australian medical data recorded between 2010 and 2015. Differences in rates of health service utilisation during this five-year period were compared between CSA victims and a age and gender matched comparison cohort without known abuse history. FINDINGS: CSA was associated with increased levels of attendance at health professionals (OR = 1.51, p < .001) for medical care and for consultations related to dental (OR = 1.28, p < .001) and chronic disease (OR = 1.23, p <.001). CSA was associated with lower mean rates of attendance at gynaecologists. Gender and age at abuse significantly influenced the relationship between CSA and frequency of health service utilisation. CONCLUSIONS: Experiencing CSA was associated with increases in rates of contact with health professionals. Abused females and victims abused after 12 years of age demonstrated the greatest elevations in rates of service utilisation. These findings have significance for both researchers in this field, and medical practitioners providing primary care.

A follow-up study of mental health service utilisation in a cohort of 2433 sexually abused Australian children utilising five years of medical data.

BACKGROUND AND OBJECTIVES: There are well established links between child sex abuse (CSA) and a range of mental health adversities in the literature. However, there has been very limited examination of mental health care needs of CSA survivors, indicated by contacts with mental health professionals. Similarly, no existing research has examined rates of prescription of psychopharmacology to CSA survivors. Service utilisation is a vital component of the health landscape, and a clear understanding of the mental health care needs of CSA survivors is central to policy formation regarding mental health funding. Therefore, this study aimed to assess differences in rates of mental health care utilisation and rates of prescription of psychopharmacology during adulthood between individuals with a history of CSA and a comparison sample from the general population without a known abuse history. PARTICIPANTS, SETTING, AND METHOD: The forensic medical records of 2433 CSA victims identified between 1964 and 1995 were linked to Australian medical and medication-use data accessed between 2010 and 2015, when victims were, on average, aged between 28.78 and 33.78 years. CSA cases were compared to a matched comparison cohort on rates of contact with mental health professionals and prescriptions for mood stabilisers, anxiolytics, antipsychotics, stimulants, analgesics and addiction treatment medication. RESULTS: CSA was associated with increased levels of attendance at psychiatrists (OR = 1.29, p < .001), psychologists and clinical social workers (OR = 6.68, p < .001) and general practitioners (OR = 1.76, p < .001) for mental health care. CSA was also associated with increased frequency of prescription of all categories of psychopharmacology (ORs ranging from 1.40 to 6.18). Outcomes differed by victim gender and age at abuse. Abused females demonstrated greater overall service and medication utilisation than abused males. Females abused after puberty (age 12 years) had more frequent contacts with general practitioners for mental health care and greater frequency of prescription of psychopharmacology than females abused under age 12 years, including elevated frequency of analgesic and mood stabiliser use. Males abused after puberty also demonstrated higher frequency of service utilisation, including inflated rates of antipsychotic and anxiolytic prescriptions and visits to psychiatrists. CONCLUSIONS: Experiencing CSA was associated with increased use of psychopharmacology and contact with health professionals for mental health care. Abused females and participants abused after age 12 demonstrated most inflated use of services. These findings have important implications for policy decisions regarding the provision of mental health care to CSA survivors deemed to be at risk of developing mental health difficulties.

Child Sexual Abuse and Criminal Offending: Gender-Specific Effects and the Role of Abuse Characteristics and Other Adverse Outcomes.

This study sought to enhance knowledge of the link between child sexual abuse (CSA) and long-term criminality by investigating gender-specific effects and the role of index sexual abuse characteristics, revictimization, and serious mental health problems. An Australian sample of 2,759 documented cases of sexual abuse and 2,677 community controls were linked to statewide police records and public mental health service databases, with a follow-up period of 13-44 years. Four key findings emerged from the analysis: (1) CSA victims were more likely than controls to engage in all types of criminal behaviors including violent, sexual, and other offending; (2) gender moderated the relationship between CSA and criminal offending, with stronger associations found among females for general and violent offending, and among males for sexual offending; (3) certain features of the index sexual abuse (i.e., developmental period, number of perpetrators, relation to perpetrator), further victimization experiences, and the development of serious mental health problems were all associated with an increased likelihood of criminal behavior among CSA victims; (4) CSA victims who engaged in criminal offending were more likely to present with cumulative risks than victims not engaging in criminal offending. Implications for future research and clinical practice are discussed.

Further victimization of child sexual abuse victims: A latent class typology of re-victimization trajectories.

The association between child sexual abuse (CSA) and risk for re-victimization is well-documented; however, less is known about the temporal progression of re-victimization experiences over the early life-course among CSA survivors, and whether this differs from that of those without known sexual abuse histories. This study investigated whether there are distinct temporal pathways of interpersonal re-victimization between the ages of 10-25 years among medically confirmed CSA cases, and considered whether abuse variables, re-victimization variables, and the presence of other adverse outcomes, were associated with heterogeneity in re-victimization pathways. The data were collected as part of a large-scale data-linkage study in which the medical records of 2759 cases of contact-CSA between 1964 and 1995 were linked, between 13 and 44 years following abuse, to police and public psychiatric databases; cases were compared to a matched community sample (n=2677). Using a subsample of 510 (401 victims; 109 comparisons) individuals with an interpersonal (re)victimization history, we examined the aggregate 'age-(re)victimization' curves for CSA victims and comparisons, respectively. Further, we applied longitudinal latent class analysis to explore heterogeneity in re-victimization trajectories among abuse survivors across their early life-course. Four latent pathways were identified, labeled: Normative; Childhood-Limited; Emerging-Adulthood; and Chronic re-victimization trajectories. Older age at abuse, a criminal history, and mental health problems were uniquely predictive of membership to the more problematic and persistent re-victimization trajectories. Findings indicate that individuals exposed to CSA during adolescence may be particularly vulnerable to poorer re-victimization trajectories, characterized by multiple risk indices, and thus may warrant increased service provision.

Exploring the longitudinal offending pathways of child sexual abuse victims: A preliminary analysis using latent variable modeling.

Very little research has been conducted to show the way in which criminal behavior unfolds over the life-course in children who have been sexually abused, and whether it differs from the 'age-crime' patterns consistently documented in the criminology literature. This study investigated the temporal pathways of criminal offending between the ages of 10-25 years among medically confirmed cases of child sexual abuse (CSA), and considered whether abuse variables, offense variables, and the presence of other adverse outcomes, were associated with heterogeneity in offending pathways among CSA survivors. This study utilized data gathered as part of a large-scale study involving the linkage of forensic examinations on 2759 cases of medically ascertained CSA between 1964 and 1995, to criminal justice and public psychiatric databases 13-44 years following abuse, together with a matched comparison sample of 2677 individuals. We used the subsample of 283 offending individuals (191 victims; 92 comparisons) for whom complete offending data were available. We compared the aggregate age-crime curves for CSA victims and comparisons, and applied longitudinal latent class analysis to identify distinct subgroups of offending pathways between ages 10-25 years within the abuse sample. Four latent pathways emerged among sexually abused offenders, labeled: Early-Onset/High-Risk/Adolescence-Limited; Intermediate-Onset/Low-Risk/Adolescence-Limited; Late-Onset/Low-Risk/Slow-Declining; and Early-Onset/High-Risk/Persistent offenders. Age at abuse, the nature and frequency of offending, and mental health problems, were associated with the offending pathway followed by CSA victims. Consistent with criminological literature, findings indicate considerable heterogeneity in the longitudinal offending patterns of offenders exposed to CSA. Implications for clinical practice and directions for research are highlighted.

The long-term co-occurrence of psychiatric illness and behavioral problems following child sexual abuse.

OBJECTIVES: There is a growing body of research investigating the relationship between child sexual abuse and a range of adverse outcomes. However, very little is known about the long-term co-occurrence of psychiatric disorders and behavioral problems among this vulnerable population, or the interaction between characteristics of the abuse, such as the nature and timing of the child sexual abuse, and the extent of subsequent adversities. This study aimed to determine the rate and co-occurrence of mental health morbidity, criminal justice system contact, and fatal self-harm among medically confirmed victims of child sexual abuse, and to identify abuse variables associated with a greater likelihood of cumulative adverse experiences. METHODS: The forensic medical records of 2759 cases of child sexual abuse assessed between 1964 and 1995 were linked with public psychiatric, criminal justice and coronial administrative databases between 13 and 44 years following abuse. Cases were compared to 2677 matched comparisons from the general population. RESULTS: Abuse victims were more likely (odds ratio = 7.2, 95% confidence interval = [4.9, 10.4], p < 0.001) to experience cumulative adverse psychiatric and behavioral problems relative to comparisons. Almost half (47.6%) of victims who died of suicide or drug overdose had a history of offending, further victimization and mental illness. Relative to comparisons, female victims demonstrated the largest increase in odds for cumulative outcomes (odds ratio = 9.8, 95% confidence interval = [5.8, 16.8], p < 0.001), whereas in absolute terms, male victims were at an elevated risk for all types and combinations of adverse outcomes, except fatal self-harm. Boys who were older at abuse, had multiple abuse episodes or who were abused by an extra-familial perpetrator were most likely to experience poorer clinical trajectories. Only being older at abuse was associated with cumulative adverse experiences for females. CONCLUSIONS: Sexual abuse, particularly during adolescence (ages 12-16 years), appears to be a risk factor for co-occurring adverse experiences. This study identifies particular groups of child sexual abuse victims as at-risk and requiring targeted intervention.