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Am J Public Health. 2001 May; 91(5): 753–760.
PMCID: PMC1446666

Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey.


OBJECTIVES: This study examined the relationship between child sexual abuse (CSA) and subsequent onset of psychiatric disorders, accounting for other childhood adversities, CSA type, and chronicity of the abuse. METHODS: Retrospective reports of CSA, other adversities, and psychiatric disorders were obtained by the National Comorbidity Survey, a nationally representative survey of the United States (n = 5877). Reports were analyzed by multivariate methods. RESULTS: CSA was reported by 13.5% of women and 2.5% of men. When other childhood adversities were controlled for, significant associations were found between CSA and subsequent onset of 14 mood, anxiety, and substance use disorders among women and 5 among men. In a subsample of respondents reporting no other adversities, odds of depression and substance problems associated with CSA were higher. Among women, rape (vs molestation), knowing the perpetrator (vs strangers), and chronicity of CSA (vs isolated incidents) were associated with higher odds of some disorders. CONCLUSIONS: CSA usually occurs as part of a larger syndrome of childhood adversities. Nonetheless, CSA, whether alone or in a larger adversity cluster, is associated with substantial increased risk of subsequent psychopathology.

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Selected References

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  • Burnam MA, Stein JA, Golding JM, Siegel JM, Sorenson SB, Forsythe AB, Telles CA. Sexual assault and mental disorders in a community population. J Consult Clin Psychol. 1988 Dec;56(6):843–850. [PubMed]
  • Yama MF, Tovey SL, Fogas BS. Childhood family environment and sexual abuse as predictors of anxiety and depression in adult women. Am J Orthopsychiatry. 1993 Jan;63(1):136–141. [PubMed]
  • Koverola C, Pound J, Heger A, Lytle C. Relationship of child sexual abuse to depression. Child Abuse Negl. 1993 May-Jun;17(3):393–400. [PubMed]
  • Cheasty M, Clare AW, Collins C. Relation between sexual abuse in childhood and adult depression: case-control study. BMJ. 1998 Jan 17;316(7126):198–201. [PMC free article] [PubMed]
  • Boudewyn AC, Liem JH. Childhood sexual abuse as a precursor to depression and self-destructive behavior in adulthood. J Trauma Stress. 1995 Jul;8(3):445–459. [PubMed]
  • Portegijs PJ, Jeuken FM, van der Horst FG, Kraan HF, Knottnerus JA. A troubled youth: relations with somatization, depression and anxiety in adulthood. Fam Pract. 1996 Feb;13(1):1–11. [PubMed]
  • Silverman AB, Reinherz HZ, Giaconia RM. The long-term sequelae of child and adolescent abuse: a longitudinal community study. Child Abuse Negl. 1996 Aug;20(8):709–723. [PubMed]
  • Levitan RD, Parikh SV, Lesage AD, Hegadoren KM, Adams M, Kennedy SH, Goering PN. Major depression in individuals with a history of childhood physical or sexual abuse: relationship to neurovegetative features, mania, and gender. Am J Psychiatry. 1998 Dec;155(12):1746–1752. [PubMed]
  • Winfield I, George LK, Swartz M, Blazer DG. Sexual assault and psychiatric disorders among a community sample of women. Am J Psychiatry. 1990 Mar;147(3):335–341. [PubMed]
  • Fergusson DM, Horwood LJ, Lynskey MT. Childhood sexual abuse and psychiatric disorder in young adulthood: II. Psychiatric outcomes of childhood sexual abuse. J Am Acad Child Adolesc Psychiatry. 1996 Oct;35(10):1365–1374. [PubMed]
  • McCauley J, Kern DE, Kolodner K, Dill L, Schroeder AF, DeChant HK, Ryden J, Derogatis LR, Bass EB. Clinical characteristics of women with a history of childhood abuse: unhealed wounds. JAMA. 1997 May 7;277(17):1362–1368. [PubMed]
  • Rowan AB, Foy DW, Rodriguez N, Ryan S. Posttraumatic stress disorder in a clinical sample of adults sexually abused as children. Child Abuse Negl. 1994 Jan;18(1):51–61. [PubMed]
  • Wolfe DA, Sas L, Wekerle C. Factors associated with the development of posttraumatic stress disorder among child victims of sexual abuse. Child Abuse Negl. 1994 Jan;18(1):37–50. [PubMed]
  • Widom CS. Posttraumatic stress disorder in abused and neglected children grown up. Am J Psychiatry. 1999 Aug;156(8):1223–1229. [PubMed]
  • Giaconia RM, Reinherz HZ, Silverman AB, Pakiz B, Frost AK, Cohen E. Traumas and posttraumatic stress disorder in a community population of older adolescents. J Am Acad Child Adolesc Psychiatry. 1995 Oct;34(10):1369–1380. [PubMed]
  • Resnick HS, Kilpatrick DG, Dansky BS, Saunders BE, Best CL. Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol. 1993 Dec;61(6):984–991. [PubMed]
  • Briggs L, Joyce PR. What determines post-traumatic stress disorder symptomatology for survivors of childhood sexual abuse? Child Abuse Negl. 1997 Jun;21(6):575–582. [PubMed]
  • Windle M, Windle RC, Scheidt DM, Miller GB. Physical and sexual abuse and associated mental disorders among alcoholic inpatients. Am J Psychiatry. 1995 Sep;152(9):1322–1328. [PubMed]
  • Miller BA, Downs WR, Testa M. Interrelationships between victimization experiences and women's alcohol use. J Stud Alcohol Suppl. 1993 Sep;11:109–117. [PubMed]
  • Klassen AD, Wilsnack SC. Sexual experience and drinking among women in a U.S. national survey. Arch Sex Behav. 1986 Oct;15(5):363–392. [PubMed]
  • Kilpatrick DG, Acierno R, Resnick HS, Saunders BE, Best CL. A 2-year longitudinal analysis of the relationships between violent assault and substance use in women. J Consult Clin Psychol. 1997 Oct;65(5):834–847. [PubMed]
  • Fendrich M, Mackesy-Amiti ME, Wislar JS, Goldstein PJ. Childhood abuse and the use of inhalants: differences by degree of use. Am J Public Health. 1997 May;87(5):765–769. [PMC free article] [PubMed]
  • Stewart SH. Alcohol abuse in individuals exposed to trauma: a critical review. Psychol Bull. 1996 Jul;120(1):83–112. [PubMed]
  • Wilsnack SC, Vogeltanz ND, Klassen AD, Harris TR. Childhood sexual abuse and women's substance abuse: national survey findings. J Stud Alcohol. 1997 May;58(3):264–271. [PubMed]
  • Brown GR, Anderson B. Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. Am J Psychiatry. 1991 Jan;148(1):55–61. [PubMed]
  • Cahill C, Llewelyn SP, Pearson C. Long-term effects of sexual abuse which occurred in childhood: a review. Br J Clin Psychol. 1991 May;30(Pt 2):117–130. [PubMed]
  • Browne A, Finkelhor D. Impact of child sexual abuse: a review of the research. Psychol Bull. 1986 Jan;99(1):66–77. [PubMed]
  • Beitchman JH, Zucker KJ, Hood JE, daCosta GA, Akman D, Cassavia E. A review of the long-term effects of child sexual abuse. Child Abuse Negl. 1992;16(1):101–118. [PubMed]
  • Briere JN, Elliott DM. Immediate and long-term impacts of child sexual abuse. Future Child. 1994 Summer-Fall;4(2):54–69. [PubMed]
  • Sheldrick C. Adult sequelae of child sexual abuse. Br J Psychiatry Suppl. 1991 May;(10):55–62. [PubMed]
  • Moore KA, Nord CW, Peterson JL. Nonvoluntary sexual activity among adolescents. Fam Plann Perspect. 1989 May-Jun;21(3):110–114. [PubMed]
  • Finkelhor D, Hotaling G, Lewis IA, Smith C. Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors. Child Abuse Negl. 1990;14(1):19–28. [PubMed]
  • Finkelhor D, Dziuba-Leatherman J. Children as victims of violence: a national survey. Pediatrics. 1994 Oct;94(4 Pt 1):413–420. [PubMed]
  • Finkelhor D. Current information on the scope and nature of child sexual abuse. Future Child. 1994 Summer-Fall;4(2):31–53. [PubMed]
  • Fergusson DM, Lynskey MT, Horwood LJ. Childhood sexual abuse and psychiatric disorder in young adulthood: I. Prevalence of sexual abuse and factors associated with sexual abuse. J Am Acad Child Adolesc Psychiatry. 1996 Oct;35(10):1355–1364. [PubMed]
  • Fleming J, Mullen P, Bammer G. A study of potential risk factors for sexual abuse in childhood. Child Abuse Negl. 1997 Jan;21(1):49–58. [PubMed]
  • Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP. Childhood sexual abuse and mental health in adult life. Br J Psychiatry. 1993 Dec;163:721–732. [PubMed]
  • Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP. The long-term impact of the physical, emotional, and sexual abuse of children: a community study. Child Abuse Negl. 1996 Jan;20(1):7–21. [PubMed]
  • Briere J, Runtz M. Differential adult symptomatology associated with three types of child abuse histories. Child Abuse Negl. 1990;14(3):357–364. [PubMed]
  • Deykin EY, Buka SL. Prevalence and risk factors for posttraumatic stress disorder among chemically dependent adolescents. Am J Psychiatry. 1997 Jun;154(6):752–757. [PubMed]
  • Bromet E, Sonnega A, Kessler RC. Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey. Am J Epidemiol. 1998 Feb 15;147(4):353–361. [PubMed]
  • Breslau N, Chilcoat HD, Kessler RC, Davis GC. Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. Am J Psychiatry. 1999 Jun;156(6):902–907. [PubMed]
  • Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997 May 17;349(9063):1436–1442. [PubMed]
  • Greenberg PE, Stiglin LE, Finkelstein SN, Berndt ER. The economic burden of depression in 1990. J Clin Psychiatry. 1993 Nov;54(11):405–418. [PubMed]
  • Greenberg PE, Sisitsky T, Kessler RC, Finkelstein SN, Berndt ER, Davidson JR, Ballenger JC, Fyer AJ. The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry. 1999 Jul;60(7):427–435. [PubMed]
  • Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994 Jan;51(1):8–19. [PubMed]
  • Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995 Dec;52(12):1048–1060. [PubMed]
  • Wittchen HU, Robins LN, Cottler LB, Sartorius N, Burke JD, Regier D. Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials. Br J Psychiatry. 1991 Nov;159:645–658. [PubMed]
  • Kessler RC, Rubinow DR, Holmes C, Abelson JM, Zhao S. The epidemiology of DSM-III-R bipolar I disorder in a general population survey. Psychol Med. 1997 Sep;27(5):1079–1089. [PubMed]
  • Kendler KS, Gallagher TJ, Abelson JM, Kessler RC. Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey. Arch Gen Psychiatry. 1996 Nov;53(11):1022–1031. [PubMed]
  • Kendler KS, Silberg JL, Neale MC, Kessler RC, Heath AC, Eaves LJ. The family history method: whose psychiatric history is measured? Am J Psychiatry. 1991 Nov;148(11):1501–1504. [PubMed]
  • Willett JB, Singer JD. Investigating onset, cessation, relapse, and recovery: why you should, and how you can, use discrete-time survival analysis to examine event occurrence. J Consult Clin Psychol. 1993 Dec;61(6):952–965. [PubMed]
  • Browne A. Family violence and homelessness: the relevance of trauma histories in the lives of homeless women. Am J Orthopsychiatry. 1993 Jul;63(3):370–384. [PubMed]
  • Bryer JB, Nelson BA, Miller JB, Krol PA. Childhood sexual and physical abuse as factors in adult psychiatric illness. Am J Psychiatry. 1987 Nov;144(11):1426–1430. [PubMed]
  • Molnar BE, Shade SB, Kral AH, Booth RE, Watters JK. Suicidal behavior and sexual/physical abuse among street youth. Child Abuse Negl. 1998 Mar;22(3):213–222. [PubMed]
  • Kendall-Tackett KA, Williams LM, Finkelhor D. Impact of sexual abuse on children: a review and synthesis of recent empirical studies. Psychol Bull. 1993 Jan;113(1):164–180. [PubMed]
  • Silk KR, Lee S, Hill EM, Lohr NE. Borderline personality disorder symptoms and severity of sexual abuse. Am J Psychiatry. 1995 Jul;152(7):1059–1064. [PubMed]
  • Kessler RC, Davis CG, Kendler KS. Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychol Med. 1997 Sep;27(5):1101–1119. [PubMed]
  • Cole PM, Putnam FW. Effect of incest on self and social functioning: a developmental psychopathology perspective. J Consult Clin Psychol. 1992 Apr;60(2):174–184. [PubMed]
  • Williams LM. Recall of childhood trauma: a prospective study of women's memories of child sexual abuse. J Consult Clin Psychol. 1994 Dec;62(6):1167–1176. [PubMed]

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