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Cited by 140Child Abuse and TraumaSexual Assault and Victimization StudiesMilitary, Security, and Education Studies

The DOI matches its Crossref record; 111 of the 111 references it cites were found in a registry or an index; none of the 29 sources its claims cite is checked for support yet.

Psychological injury in victims of child sexual abuse: A meta-analytic review

Open access
Amado, Bárbara G., Arce, Ramón, Herraiz, Andrés·2015·Psychosocial Intervention
DOI 10.1016/j.psi.2015.03.002
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Abstract

In order to assess the effects of child/adolescent sexual abuse (CSA/ASA) on the victim's probability of developing symptoms of depression and anxiety, to quantify injury in populational terms, to establish the probability of injury, and to determine the different effects of moderators on the severity of injury, a meta-analysis was performed. Given the abundant literature, only studies indexed in the scientific database of reference, the Web of Science, were selected. A total of 78 studies met the inclusion criteria: they measured CSA/ASA victimization or injury in terms of depression or anxiety symptoms, measured the effect size or included data for computing them, and provided a description of the sample. The results showed that CSA/ASA victims suffered significant injury, generally of a medium effect size and generalizable, victim shad 70% more probabilities of suffering from injury, and clinical diagnosis was significantly a more adequate measure of injury than symptoms. The probability of chronic injury (dysthymia) was greater than developing more severe injury, i.e., major depressive disorder (MDD). In the category of anxiety disorders, injury was expressed with a higher probability in specific phobia. In terms of the victim's gender, females had significantly higher rates of developing a depressive disorder (DD) and/or an anxiety disorder(AD), quantified in a 42% and 24% over the baseline, for a DD and AD respectively. As for the type of abuse, the meta-analysis revealed that abuse involving penetration was linked to severe injury, whereas abuse with no contact was associated to less serious injury. The clinical, social, and legal implications of the results are discussed.

Overview

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Written from the paper’s full text.

TL;DR

This meta-analysis of 78 studies (19,360 subjects; 149 effect sizes) found that child/adolescent sexual abuse victims had significant, generalizable, medium-sized psychological injury in depression and anxiety, with about 70% higher probability of internalizing injury than non-victims. Clinical diagnosis was more sensitive than symptoms, dysthymia exceeded major depression, specific phobia was highest among anxiety disorders, females showed higher diagnosed depression/anxiety, and penetrative abuse was linked to greater injury than no-contact abuse.

Key findings

  • CSA/ASA victims showed significant, positive, generalizable injury of medium size: victims had a 70% higher probability (CLES) of general internalizing injury than non-victims, 66% for depression, and 68% for anxiety; injury was quantified as 34%, 28%, and 31% for general sequelae, depression, and anxiety, respectively. The paper reports that 93 studies with non-significant results would be required to accept the null hypothesis.
  • Clinical diagnosis was a significantly more adequate measure of injury than symptoms: anxiety diagnosis vs. anxiety symptoms, q_s = 0.152, p < .01; depressive diagnosis vs. depressive symptoms, q_s = 0.108, p < .05. Dysthymia had an odds ratio of 6.59 vs. 3.25 for major depression, with injury of 46% vs. 31%, and the difference was significant, q_s = 0.176, p < .01. Specific phobia had the highest anxiety-disorder odds ratio (7.62) and injury (49%), significantly higher than social phobia (q_s = 0.112, p < .05) and generalized anxiety disorder (q_s = 0.100, p < .05).
  • Gender moderated diagnosed outcomes: female victims had 42% injury for depressive disorder and 24% for anxiety disorder, with odds ratios of 5.40 and 2.43 vs. non-victims; male victims had 10% and 14%, with odds ratios of 1.44 and 1.66. Depressive disorder effects were significantly higher in females, q_s = 0.093, p < .05, and anxiety disorder effects were significantly higher in females, q_s = 0.104, p < .05; anxiety symptoms were significantly higher in males, q_s = 0.095, p < .05, with odds ratios of 2.76 for males vs. 1.95 for females.
  • Abuse involving penetration was linked to significantly greater injury than no-contact abuse for depression, q_s = 0.093, p < .05, and anxiety, q_s = 0.092, p < .05.

Methods

  • Meta-analysis of studies indexed in Web of Science, restricted to publications since 1995; 78 studies met inclusion criteria, totaling 19,360 subjects and 149 effect sizes (62 for anxiety, 87 for depression). Inclusion required measurement of CSA/ASA victimization or injury in terms of depression/anxiety, effect-size data or computable statistics, sample description, ground truth for abuse classification, and mutual exclusion from other maltreatment.
  • Main analysis used a correlational meta-analytic procedure (Hunter & Schmidt, 2004), weighting effect sizes by sample size and correcting for predictor and criterion reliability. Various statistics were converted to correlations, Cohen’s d, or Hedges’ g; U1, odds ratio, and CLES were calculated; outliers ±2 SD were removed, eliminating 6 studies.
  • Moderators examined were gender, type of measure (clinical diagnosis vs. symptoms), type of abuse (no contact, contact, penetration), and the interaction of type of measure and gender.

Limitations

  • Stated in the paper: primary studies’ abuse classification generally rests on retrospective self-report, with memory limitations and false positives/false negatives, especially for males; primary studies assume injury is sequelae to abuse without appraising other possible causes; effects were not completely isolated from physical abuse, neglect, and other categories; and some studies lacked control groups, so the normative population was used as contrast, potentially distorting effect sizes.
  • Stated in the paper: some moderator analyses had very small k (e.g., male anxiety disorder diagnosis k = 4; specific phobia k = 3), and the paper notes that moderators could not be assessed in some cases and further research is required.
  • Evident from the text: inclusion was restricted to Web of Science-indexed, post-1995 studies and English/Spanish descriptors, which may limit coverage; several meta-analytic cells show low %VE (e.g., 2.82% for general sequelae), indicating substantial unexplained heterogeneity.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.psi.2015.03.002

Cites

111 of 111 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 29 cited sources checked · 0 supported · 0 flagged

Show all 47 claims

  • It may state two separate claims as one. 49
  • Probably not a substantial claim. 5
52 of 52

  • The authors state this as an assumption.

    Injury associated to CSA/ASA victims is general.

    “Though injury associated to CSA/ASA victims is assumed to be general, certain moderators are expected to explain differences in the degree of injury.”

  • The paper relies on this without support.

    Injury to mental health is sequelae to abuse (cause-effect relationship).

    “primary studies assume that injury to mental health is sequelae to abuse, without appraising other possible causes (cause-effect relationship) (Jumper, 1995;Vilariño et al., 2013).”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Limitation conflicts with the stated exclusion rule

    Minor

    The methods say studies that did not separate sexual-abuse victims from other maltreatment categories were excluded. The limitations instead say that many primary studies grouped those categories together, preventing the effect from being isolated.

  • Male anxiety-symptom sample total is smaller than its two groups

    Minor

    Table 7 reports 153 participants in the experimental group and 594 in the control group, which sum to 747, not the reported total of 727.

    Reported 727 · recomputed 747

  • The stated total subject count is also labeled the experimental-group count

    Minor

    The methods call 19,360 the total number of subjects, but Table 3 labels 19,360 as the experimental-group sample for general sequelae and separately lists a control group and a larger total.

3 of 3

Citations

Cites

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Show all 111 references

Research works printed but not linked: 2

  1. Nunnally, J.C., & Berstein, I.H. (1994). Psychometric theory (3rd ed.). New York, NY: McGraw-Hill.
  2. World Health Organization. (2000). Women's mental health: An evidence based review. Geneva, Switzerland: Author.

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Metadata

Authors
Amado, B. G., Arce, R., & Herraiz, A.
Affiliations
Universidade de Santiago de Compostela (ES)
ORCID
Amado, Bárbara G.
Venue
Psychosocial Intervention
Publisher
Colegio Oficial de la Psicologia de Madrid
Published
2015-01
Volume
24
Issue
1
Pages
49-62
ISSN
1132-0559 (ISSN-L)
DOI
10.1016/j.psi.2015.03.002
OpenAlex
W1978637848
Cited by
140
References
111
Citations by year
2026: 14 · 2025: 13 · 2024: 15 · 2023: 18 · 2022: 28 · 2021: 11 · 2020: 12 · 2019: 15 · 2018: 6 · 2017: 4 · 2016: 4
FWCI
5.79
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychosocial Intervention (publishedVersion, cc-by-nc-nd)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Hispana (submittedVersion, cc-by-nc-nd)
  • Repositorio institucional da Universidade de Santiago de Compostela (University of Santiago de Compostela) (submittedVersion, cc-by-nc-nd)
  • Redalyc (Universidad Autónoma del Estado de México) (submittedVersion)
  • Scientific Electronic library online (Sciences Carlos III Health Institute) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Gender Studies › Sexual Assault and Victimization Studies
  • Social Sciences › Sociology and Political Science › Military, Security, and Education Studies
Keywords
child sexual abuse, adolescent sexual abuse, psychological harm, depression, anxiety disorders, major depressive disorder, dysthymia, specific phobia, gender differences, sexual penetration

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