Elsevier

The Lancet

Volume 358, Issue 9280, 11 August 2001, Pages 450-454
The Lancet

Articles
Relation between childhood sexual and physical abuse and risk of revictimisation in women: a cross-sectional survey

https://doi.org/10.1016/S0140-6736(01)05622-7Get rights and content

Summary

Background

Women who are physically and sexually abused in childhood are at increased risk of victimisation in adulthood. Research has concentrated on sexual revictimisation, and has not included investigation of other abusive experiences, nor examination of prevalence and effects of abuse on adult revictimisation. We aimed to examine the relation between childhood trauma and adult revictimisation, and identify confounding factors.

Methods

We did a cross-sectional survey of 2592 women who were attending primary care practices in east London, UK, with self-administered anonymous questionnaires. We included questions on physical and sexual abuse in childhood; on domestic violence, rape, indecent assault, and other traumatic experiences in adulthood; and on alcohol and other drug abuse. We analysed associations between childhood and adulthood abuse with multiple logistic regression.

Findings

1207 (55%) of 2192 eligible women were recruited and completed the questionnaire. Abusive experiences cooccurred in both childhood and adulthood. Repetition and severity of childhood abuse were independently associated with specific types of adult revictimisation. Unwanted sexual intercourse (<16 years) was associated with domestic violence in adulthood (odds ratio 3·54; 95% CI 1·52–8·25) and with rape (2·84; 1·09–7·35); and severe beatings by parents or carers with domestic violence (3·58; 2·06–6·20), rape (2·70; 1·27–5·74), and other trauma (3·85; 2·23–6·63).

Interpretation

Childhood abuse substantially increases risk of revictimisation in adulthood. Women who have experienced multiple childhood abuse are at most risk of adult revictimisation. Identification of women who have undergone childhood abuse is a prerequisite for prevention of further abuse.

Introduction

Childhood maltreatment is a major health problem that is associated with a wide range of physical conditions, and leads to high rates of psychiatric morbidity and social problems in adulthood. Women who were abused as children have an increased risk of abuse in adulthood.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16 Research has been focused mainly on whether childhood sexual abuse increases risk of sexual assault in adulthood. Results from a few studies have suggested that childhood sexual abuse increases the risk of domestic violence.2, 4, 5 A substantial proportion of women who were victims in childhood have also reported more than one form of abuse. We do not know whether multiple abusive experiences further increase the risk of abuse in adulthood, and little research has been done on possible associations between childhood abuse and similar or equivalent forms of abuse in adulthood. One group of investigators17 has shown that after controlling for confounding between childhood sexual and physical abuse, physical abuse was unrelated to rape in adulthood in female naval recruits. Nevertheless, sexual abuse per se might not be a specific or unique predisposing factor, and could be merely one of several abusive experiences in childhood that could increase vulnerability to various forms of abuse and revictimisation in adulthood.18 Different types of childhood abuse could be broadly defined as early stress—which increases the risk of abusive experiences in adulthood—rather than specific antecedents to adult experiences.

Few researchers have investigated revictimisation or examined an adequate range of abusive experiences in childhood and adulthood. Few data exist on other factors that could be associated with childhood experiences of abuse and further increase risk of revictimisation. Most studies of adult revictimisation have included selected populations,2, 3, 4, 5, 17, 19 but some have been community based9, 13, 16 or have included students.1, 10, 11, 12, 14, 15, 18 Small sample sizes have weakened the conclusions that could be drawn from some studies. Furthermore, definitions of abusive experiences and their degree of severity differ considerably between studies. Childhood sexual abuse can mean anything from exhibitionism to rape, with upper age limits of abuse varying from 14 to 18 years, and with little objective justification for these criteria.16

We have surveyed women who were attending primary care in east London to assess the prevalence of selfreported childhood and adult abusive and traumatic experiences, measure the association between childhood abuse and adult abuse and trauma, test for specific or generalised associations between different forms of childhood and adult abuse, and identify factors that could confound the relation between childhood and adult abuse.

Between January and December, 1999, we surveyed adult female patients (16 years or older) in 13 general practices in Hackney, an innercity area of east London with substantial socioeconomic deprivation. We generated a list in random order of all 51 practices in Hackney and approached them in consecutive order until 13 were recruited. Six practices declined to participate. Consecutive eligible female patients attending surgeries were invited to take part in the survey, and recruitment took place in seven randomised sessions per week for 2–4 weeks in each practice. Women were eligible to participate if they were registered with the practice, and were able to read English, Turkish, or Bengali (the questionnaire was translated into these languages). Those who were nursing an infant or who were too ill to participate were excluded.

If an adult female patient were eligible to participate, a research assistant introduced the woman to the survey and explained the aim of the study. Women were told that participation was voluntary, and that all information disclosed would be confidential and would not be given to their doctor or entered in their medical record. Before patients' recruitment we gave family practitioners and practice nurses an information pack that detailed local support and housing services for abused women. The survey questionnaire included an information sheet explaining the study in detail, a sheet detailing local support services for women, and a written consent form. Women were encouraged to take the information and support services sheet away with them.

We developed a self-administered questionnaire specifically for the survey. The questionnaire included demographic details; CAGE20 questions to assess current and past alcohol abuse, self-reported use of illicit (street) drugs, and whether the woman had ever had difficulty reducing or controlling drug use; questions on violence in relationships, unwanted sexual experiences in childhood and adulthood, attitude to being questioned by their family practitioner or practice nurse about domestic violence and sexual abuse; and self-reported criteria for DSM-IV post traumatic stress disorder.21

Domestic violence was defined22 as a yes response to one or more questions about physical assault, or to a question about whether they had been forced to have sex by a present or any previous partner. Women were asked whether they had had unwanted sexual intercourse with anyone when they were a child (younger than 16 years) and whether they had been involved in unwanted sexual activities that had never reached full sexual intercourse. They were also asked whether they had been raped aged 16 years or older, and whether they had been sexually assaulted, but not raped. Women were asked whether as children they had been severely beaten by a parent, stepparent, or carer on one or more occasions. To establish the presence or absence of additional trauma, we asked them to think of events that had happened to them throughout their life: whether they had ever seen something so horrifying or frightening, or had had something so horrible happen to them, that they kept having dreams or nightmares or kept remembering it when they did not want to; whether this trauma included sexual abuse before age 16 years, sexual assault or rape aged 16 years or older, domestic violence, or “something else that you saw or that happened to you?” A positive answer to this last question was defined as an additional non-specific, or other traumatic event.

We aimed to recruit 5% of all women registered at every practice, which we achieved in 11 of the 13 practices. Women completed the survey questionnaire in the waiting room at each practice, and were asked not to take the questionnaire home. In one waiting area, seating arrangements made physical access to the women difficult. In another practice, a large proportion of patients was Orthodox Jewish, and the survey coincided with a religious period in which women were not allowed to write. These factors reduced the number of women willing to take part in the survey in these two practices.

The study was approved by the East London and City health authority research ethics committee. We were not given permission to collect information from medical records about patients who declined participation in the study.

Data analysis was done with SAS statistical software, version 6·12. Univariate analyses were used to examine associations between demographic characteristics and adult experiences of abuse and trauma, with X2 test for frequencies. Multiple logistic regression models were constructed to investigate associations between childhood abuse variables and adult experiences, after adjustment for variables thought likely to confound the relation and affect the response rate. We adjusted for age, ethnic origin, education, home ownership, marital status, whether place of birth was the UK, and family practice. Odds ratios relative to a baseline reference were estimated for all these categories. Values for odds ratios were linked to adult experience—ie, values greater than one indicate an increased risk of a particular adult experience, and values less than one indicate a reduced risk of a particular adult experience.

Section snippets

Results

2592 women attended the surgeries: 243 (9%) were not approached because they seemed too ill to participate or were nursing an infant, and 157 (6%) were ineligible because they were unable to speak sufficient English to give consent. We approached 2192 women in waiting rooms; 781 (36%) refused to complete the questionnaire; 1411 (64%) consented and were eligible to take part in the survey. However, 169 (12%) women were called to see their doctor or practice nurse before they could sufficiently

Discussion

We have shown that childhood abuse is independently associated with adult abuse and trauma, after adjustment for significant confounding variables. We have confirmed that experiences of abuse do not occur in isolation; women who had had unwanted sexual intercourse in childhood were likely to experience other forms of unwanted sexual activity; and the occurrence of either of these increased their risk of physical abuse.

Less severe experiences of childhood abuse were specifically associated with

References (34)

  • E Deblinger et al.

    Posttraumatic stress in sexually abused, physically abused, and non abused children

    Child Abuse Negl

    (1989)
  • DJ Kolko et al.

    Behavioural/emotional indicators of sexual abuse in child psychiatric inpatients: a controlled comparison with physical abuse

    Child Abuse Negl

    (1988)
  • PC Alexander et al.

    Family characteristics and long-term consequences associated with sexual abuse

    Arch Sex Behav

    (1987)
  • J Briere et al.

    Post sexual abuse trauma: data and implications for clinical practice

    J Interpersonal Violence

    (1987)
  • M Cloitre et al.

    Childhood abuse and subsequent sexual assault among female inpatients

    J Trauma Stress

    (1996)
  • DuttonMA et al.

    Battered women's cognitive schemata

    J Trauma Stress

    (1994)
  • A Kemp et al.

    Post-traumatic stress disorder PTSD) in battered women: a shelter sample

    J Trauma Stress

    (1991)
  • CA Gidycz et al.

    Sexual assault experience in adulthood and prior victimisation experiences: a prospective analysis

    Psychol Women Q

    (1993)
  • M Gorcey et al.

    Psychological consequences for women sexually abused in childhood

    Soc Psychiatry

    (1986)
  • JL Jackson et al.

    Young adult women who report intrafamilial sexual abuse: subsequent adjustment

    Arch Sex Behav

    (1990)
  • DG Kilpatrick et al.

    A 2-year longitudinal analysis of the relationship between violent assault and substance use in women

    J Consult Clin Psychol

    (1997)
  • MP Koss et al.

    Discriminant analysis of risk factors for sexual victimisation among a national sample of college women

    J Consult Clin Psychol

    (1989)
  • CA Mandoki et al.

    Sexual Victimization: is there a vicious cycle?

    Violence Vict

    (1989)
  • A Mayall et al.

    Definitional issues and mediating variables in the sexual revictimisation of women sexually abused as children

    J Interpersonal Violence

    (1995)
  • DEH Russell
  • MR Stevenson et al.

    Unwanted childhood sexual experiences relate to later revictimisation and male perpetration

    J Psychol Human Sexuality

    (1992)
  • AJ Urquiza et al.

    Child sexual abuse and adult revictimisation with women of color

    Violence Vict

    (1994)
  • Cited by (0)

    View full text