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Jonssonetal.
Child Adolesc Psychiatry Ment Health (2019) 13:32
https://doi.org/10.1186/s13034-019-0292-1
RESEARCH ARTICLE
Online sexual abuse ofadolescents
byaperpetrator met online: across-sectional
study
Linda S. Jonsson1*, Cecilia Fredlund2, Gisela Priebe3, Marie Wadsby2 and Carl Göran Svedin1
Abstract
Background: The current study aimed at exploring adolescents’ experiences of online sexual contacts leading to
online sexual abuse by a perpetrator whom the victim had first met online. Associations with socio demographic
background, experience of abuse, relation to parents, health and risk behaviors were studied.
Methods: The participants were a representative national sample of 5175 students in the third year of the Swedish
high school Swedish (M age = 17.97). Analyses included bivariate statistics and stepwise multiple logistic regression
models.
Results: In total 330 (5.8%) adolescents had gotten to know someone during the preceding 12 months for the pur-
pose of engaging in some kind of sexual activity online. Thirty-two (9.7%) of those, the index group, had felt that they
had been persuaded, pressed or coerced on at least one occasion. Sexual interaction under pressure was seen as con-
stituting sexual abuse. These adolescent victims of online sexual abuse, the index group, did not differ with respect to
socio-demographic background from the adolescents without this experience, the reference group. The index group
had significantly more prior experiences of different kind of abuse, indicating that they belong to a polyvictimized
group. More frequent risk behavior, poorer psychological health, poorer relationships with parents and lower self-
esteem also characterized the index group. Online sexual abuse, without experiences of offline abuse, was associated
with a poorer psychological health, at least at the same level as offline sexual abuse only.
Conclusions: The study made clear the importance of viewing online sexual abuse as a serious form of sexual abuse.
Professionals meeting these children need to focus not only on their psychological health such as symptoms of trauma
and depression but also need to screen them for online behavior, online abuse and other forms of previous abuse.
Keywords: Adolescent, Sexual abuse, Online, Health
© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
(http://creat iveco mmons .org/licen ses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
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and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/
publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Introduction
Voluntary online sexual exposure
Most children in western countries use the internet daily
[1]. Among 17year olds in Sweden the figure is 98% [2].
e internet is mostly used for doing schoolwork, playing
online games and watching film clips, but many young
people also use it to stay in contact with people and to
meet new people for friendship, love and/or sex [2, 3].
One behavior that has been well studied recently is that of
young people sending or receiving nude images of them-
selves, so called sexting. e prevalence of sexting varies
between 2.5 and 21% depending on definition of sexting
and methodology used. Sexting is more common among
girls than boys [4, 5]. In a Swedish study of 18-year-old
students, 20.9% had engaged in some form of voluntary
sexual exposure online by posting pictures of themselves
partially undressed, flashing, masturbating, or hav-
ing sex on webcam [6]. Similar results were reported by
the same group from a study 5years later where 21% of
18-year old students reported having posted or sent nude
images [7]. e motivations for sexting have been found
Open Access
Child and Adolescent Psychiatry
and Mental Health
*Correspondence: linda.s.jonsson@liu.se
1 Barnafrid, Child and Adolescent Psychiatry, Department of Clinical
and Experimental Medicine, Faculty of Medicine, Linköping University,
581 83 Linköping, Sweden
Full list of author information is available at the end of the article
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Jonssonetal. Child Adolesc Psychiatry Ment Health (2019) 13:32
to sometimes be for reasons other than sexual; many
individuals who engage in texting say they do it for fun,
to receive confirmation, to be seen by other, or because
they think it is expected from them by their partner when
in a relationship. Sexting can also be done because a
person has been threatened to send a nude image [8] in
such cases an important boundary has been crossed into
involuntary abusive situation.
Online sexual abuse
Even if most sexual contacts online are voluntary and do
not involve anything that might be seen as sexual abuse,
there is always a possibility that children can be sexually
abused online. One well studied area involving possi-
ble sexual abuse concerns unwanted sexual approaches,
especially those made by an adult who contacts children
for sexual purposes. In a Swedish study of 14–15 year
old children, 30% (48% of the girls and 18% of the boys)
reported that unknown adults had made contact with
them via the internet and made suggestions of a sexual
nature during the preceding year [9]. Sexual approaches
were experienced more often by girls than boys and were
also more common among older adolescents and those
defining themselves as gay, bisexual or as being unsure
about sexual orientation [7]. Wolak etal. [10] found that
the group most vulnerable to sexual approaches and
grooming tend to consist of high-risk youths with a prior
history of sexual abuse. Individuals who use chatrooms,
communicate with people met online, engage in sexual
behavior online and who share personal information
online also place themselves at risk [11–13]. Baumgartner
etal. [14] found that adolescents taking most risks online
also were more likely to face negative consequences such
as abusive situations than those who did not engage in
risky online behavior. ese adolescents were more likely
to be sensation seekers who have a low level of satisfac-
tion with their lives and/or who have family difficulties.
Livingstone and Smith [15] found that fewer than one
in five adolescents were affected by negative sexual expe-
riences online. Hamilton-Giachritsis etal. [16] found in
their study (including interviews and a questionnaire) of
children victims of online sexual abuse, that the abuse
involved control, permanence, black mail, re-victimiza-
tion and self-blame. Among the participating children
who were screened for post traumatic stress, four out of
five had a score consistent with a diagnosis of posttrau-
matic stress. e study showed the seriousness of online
sexual abuse and that the victims need professional sup-
port. Except for the study by Hamilton-Giachritsis etal.
[16] the subject of online sexual abuse and the effects that
follow have only been sparsely studied.
Aim
e current study aimed to study experience that Swed-
ish adolescents have had of sexual abuse by a person met
online.
is study focused on the association of online sexual
abuse with:
• Socio-demographic background
• Experiences of emotional-, physical- and sexual
abuse
• Psychological health
• Relationships with parents
• Risk behaviors, including internet behavior.
Methods
Participants
e study population consisted of a representative sam-
ple of Swedish high school seniors in their third and last
year at Swedish high school when most were 18years old.
In Sweden, about 91% of all 18-year-old adolescents are
enrolled in high school [17]. e Swedish agency, Sta-
tistics Sweden, selected schools that might participate
based on information from the Swedish National School
Register. Stratification was made on the basis of school
size and educational programs (20 programs ranging
from those with a vocational profile to those designed to
prepare students for entrance into a university) as indi-
cated by data in the National School Register for second
year high school student, in the fall term, 2013. One or
two study programs were selected from each school.
A total of 13,903 adolescents from 261 of 1215 Swed-
ish high schools were selected and of the 261 schools
238 met the criteria for selection in 2014. An additional
sample from Stockholm County was selected using the
same selection criteria. e response rate for Stockholm
county was lower (48.7%) than for the rest of the coun-
try (65.3%). Differences were also seen regarding the
size of schools. In Stockholm, fewer of the respondents
came from schools with 10–190 pupils (13.9%) compared
to the rest of the country (22.1%) and more often came
from middle-size schools with 191–360 pupils (51.2%)
compared to the rest of the country (41.6%), resulting in a
small effect size (Cramer’sV = .10). Few differences were
found between the sample from Stockholm and the rest
of the country, so answers from Stockholm were used in
this study.
Finally, 171 schools with 9773 adolescents agreed to
participate in the study and 5873 students in these com-
pleted the questionnaire. irty-four questionnaires were
excluded due to unserious answers or a high amount of
missing data, leaving 5839 satisfactory questionnaires.
is gave a response rate of 59.7%. e mean age of the
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Jonssonetal. Child Adolesc Psychiatry Ment Health (2019) 13:32
participants was 17.97 (SD = .63). An additional 124
questionnaires were excluded since the index question,
“Have you gotten to know anyone on the internet dur-
ing the last 12months that you had sex with online?” was
not answered. e final sample consisted of 5715 ado-
lescents. Participants who answered that they had felt
persuaded, pressed or coerced when having sex online
(sexually abused online) during the last year, constituted
the index group and all other adolescents constituted the
reference group.
Procedure
e national agency Statistics Sweden distributed and
collected the questionnaires. Information about the
study was sent to the principals of the selected schools
by mail in August 2014. Questionnaires were answered in
digital format by entered answers into computers in 165
schools, where computers were not available, students
filled in paper copies of the questionnaire (six schools).
A reminder was sent to the schools that had not delivered
data by the end of the first month. Information about the
study was given to the principals and to the teachers in
charge when the questionnaires were to be filled. Stu-
dents gave their informed consent for participation by
answering the questionnaire. All participating students
received written information about where to turn for
help and support if needed at any time after the day on
which they had submitted the completed questionnaire.
Measures
e questionnaire used in the present study was a modi-
fied version of a questionnaire used in two previous stud-
ies carried out in 2004 and 2009 (Svedin and Priebe [18,
19]). It comprised 116 main questions. Questions con-
cerned socio-demographic background, experiences of
abuse, and risk behaviors. In addition, three standardized
instruments measuring relationships with parents and
psychosocial health were used.
Socio‑demographic background
Demographic questions were drawn up for the purpose
of the study (listed in Table 2a). e adolescents self-
reported the demographic information.
Abusive experiences
Sexual abuse was measured using the question: “Have
you been exposed to any of the following against your
will”, followed by six examples (someone flashed in front
of you, touched your genitals, you masturbated someone,
vaginal, oral, vaginal or anal penetration). e answers
were analyzed in two categories, any sexual abuse (all
questions) and penetrative abuse (oral, anal or genital
penetration), see Table2b.
Emotional abuse was measured using the question:
“Have you prior to the age of 18 been subjected to any
of the following by an adult”, with these three examples:
been insulted, threatened to be hit, or been isolated from
friends, see Table2b. Participants who answered “yes” to
one or more of the questions were considered victims of
emotional abuse.
Physical abuse was measured using the same word-
ing used for emotional abuse, but with eight examples
of physical abuse (Table2b). Participants who answered
“yes” to one or more of the questions were considered
victims of physical abuse.
Relationships withparents
e Parental Bonding Instrument [20, 21] is an instru-
ment that measures an individual’s perception of paren-
tal styles during childhood. e instrument consists of 25
items, where 12 relate to the subscale “care” and 13 relate
to the subscale “overprotection”. e response options
are presented on a 4-point scale, from “very like” to “very
unlike”. e total score for “care” ranges from 0 to 36 and
from 0 to 39 for “overprotection”. Items assess perception
of maternal and paternal behaviors separately. PBI has
been evaluated as an attachment instrument with strong
psychometric properties in a review by Ravitz etal. [22].
Cronbach’s alpha for mother care in the present sample
was .87, and for father care .89. Mother and father over-
protection were .84, and .78, respectively.
Self-esteem was measured by the Rosenberg self-
esteem scale [23]. e instrument measures self-esteem
using 10 items with four possible answers, ranging from
“strongly agree” to “strongly disagree”. e total score
varies between 0 and 30, with high scores correspond-
ing to high self-esteem. In the current sample, Cronbach’s
alpha for the total scale was .90.
Trauma symptoms were measured using the Trauma
Symptom Checklist for Children [TSCC: 24, 25]. e
questionnaire includes 54 questions that can be divided
into six categories: anxiety, depression, post-traumatic
stress, sexual concerns, dissociation and anger. Response
options are “never”, “sometimes”, “often” and “almost all of
the time”. Cronbach’s alpha in the present sample was .95
for the full instrument and .79–.88 for the six subscales.
Risk behaviors
Health-risk behaviors were measured using questions
related to sexual or non-sexual risk-taking. Non-sexual
risk-taking was measured with questions about use of
alcohol and drugs, see Table5.
Sexual risk-taking behaviors were measured using
questions about age of onset for sexual debut and having
had more than six sexual partners, see Table5.
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Jonssonetal. Child Adolesc Psychiatry Ment Health (2019) 13:32
Internet behavior was measured with questions about
time spent on the internet and seven questions mainly
about sexual behavior on the internet during the last year,
see Table5.
Pornography consumption was measured by two ques-
tions, see Table5.
Data analyses/statistics
Bivariate statistical analyses were performed using
Pearson’s Chi square statistics on categorical variables.
Kolmogorov–Smirnoff test was performed to examine
whether the PBI, Rosenberg, and TSCC scales (totals and
subscales) could be assumed to be normally distributed.
As these tests indicated that they were not normally dis-
tributed, bivariate analyses on these variables were per-
formed using Mann–Whitney’s U test.
Furthermore, as there were too many variables to
be included in a multiple logistic regression model, the
number of variables to be included in a “final model” was
reduced by performing stepwise multiple logistic regres-
sion analyses for each main table separately (each table
identifies different group of factors that could be associ-
ated with sexual abuse on the internet, Table4 excluded),
Table6.
All analyses were performed using SPSS, version 22.0
(IBM Inc., Armonk, NY). A p value < .05 (two-sided) was
considered statistically significant.
Ethics
e study was approved by the Regional Ethical Review
Board of Linköping (Dnr, 131–31).
Results
Online sexual abuse
Of the total of 5715 students who answered the ques-
tion about the experience of having sex online, 330 (5.8%)
answered that they had had sex online on at least at one
occasion during the preceding 12monthswith a person
met online (Table1). It was more common for boys than
girls (8.3% vs. 3.7%, p < .001) to have had that experience,
along with those who did not identify themselves as male
or female (9.4%). Of the 330 students who had had sex
online, 32 (9.7%), the index group, felt persuaded, pressed
or coerced. It was more common for girls than for boys to
have had the experience of sexual abuse online (12.8% vs.
7.2, p = .018).
ere was a difference in age between those in the ref-
erence group who had met a person online for a volun-
tary sexual experience (n = 298) and those in the index
group. ose in the index group had more often met with
older persons than for those in the reference group (78.1
vs. 53.4%, p = .007) who more often met someone of the
same age.
Sociodemographic background
e students in the index group generally had a slightly
less favorable background as concerned these factors:
parents more often unemployed and/or had a lower level
of education, students did not live with their parents less
often, less often took university-oriented study programs,
more often had an immigrant background, and were
more likely to have a poorer financial situation, than the
students in the reference group. However, these differ-
ences were not statistically significant (Table2a).
Table 1 Online sexual abuse
a Chi square test all groups
b Chi square test between boys and girls
c Of those who answered Yes on the rst question
All
n = 5715 Boy
n = 2519 Girl
n = 3143 Doesn’t t
n = 53 p-value
n % n % n % n % p
Have you got to know anyone on the internet during the last 12 months that you had sex with online?
No 5385 94.2 2311 91.7 3026 96.3 48 90.6 < .001a,b
Yes 330 5.8 208 8.3 117 3.7 5 9.4
Yes, once 191 3.3 110 4.4 77 2.4 4 7.5
Yes, several times 139 2.4 98 3.9 40 1.3 1 1.9
Did you felt persuaded, pressed or coerced at any time?c
No 298 90.3 193 92.8 102 87.2 3 60.0 .018a, nsb
Yes 32 9.7 15 7.2 15 12.8 2 40.0
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Jonssonetal. Child Adolesc Psychiatry Ment Health (2019) 13:32
Experience ofother forms ofabuse
As seen in Table2b, students in the index group had been
significantly more often exposed to different forms of
abuse during their childhood than those in the reference
group. For example, students in the index group were five
times as likely to have experienced penetrative sexual
abuse outside the internet than those in the reference
group (33.3% vs. 6.4%, p < .001), and two times as likely to
have had some kind of prior experience of physical abuse
(65.6% vs. 31.0%, p < .001).
Parental bonding, self-esteem andtrauma symptoms
Table 3 shows that the students in the index group
reported significantly poorer relationships with both
Table 2 Online sexual abuse—socio-demographic background (a) andexperience ofother forms ofabuse (b)
a p-value based on Chi square or Fisher’s exact test
Not sexually abused
ontheinternet
N = 5258–5685
Sexually abused ontheinternet
N = 30–32 p-valuea
N % N % p
a. Socio-demographic background
Fathers working 4987 88.0 25 78.1 ns
Mothers working 4950 87.4 26 81.3 ns
Fathers with university education 2285 40.2 10 31.3 ns
Mothers with university education 2963 52.1 15 46.9 ns
Living situation
With both parents or alternating 4058 71.4 19 59.4 ns
With one parent with or without a new partner 1208 21.3 12 37.3 ns
Alone with sibling or partner 377 6.6 1 3.1 ns
In foster care or institution 37 .7 0 .0 ns
Study program
Theoretical 4047 71.2 20 62.5 ns
Immigrant background (self or at least one parent with immi-
grant background) 1574 27.7 13 40.6 ns
Family financial situation
Good 4516 79.5 21 65.6 ns
Poor 981 17.3 8 25.0 ns
Don’t know 185 3.3 3 9.4 ns
b. Other forms of abuse
Sexual abuse
Any sexual abuse 1085 20.6 17 56.7 < .001
Only penetrative abuse 335 6.4 10 33.3 < .001
Emotional abuse
Any emotional abuse 3276 57.8 26 81.3 .007
Insult 3100 54.7 24 75.0 .021
Threats of hitting 1113 19.6 18 56.3 < .001
Isolation from friends 938 16.5 15 46.9 < .001
Physical abuse
Any physical abuse 1756 31.0 21 65.6 < .001
Pushed, shaken 1343 23.7 17 53.1 < .001
Hit with hands 814 14.4 16 50.0 < .001
Throw something 763 13.5 10 33.3 .005
Kick, bite, hit with fist 315 5.6 8 25.0 < .001
Strangle 208 3.7 7 21.9 < .001
Hit with objects 196 3.5 3 9.4 ns
Burn, scald 99 1.7 3 9.4 .019
Other physical assault 466 8.2 11 34.4 < .001
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Jonssonetal. Child Adolesc Psychiatry Ment Health (2019) 13:32
their mothers and fathers than those in the reference
group as indicated by experienced less parental care
and more parental overprotection.
Self-esteem measured by Rosenberg self-esteem scale
was significantly lower in the index group than in the
reference group (M = 15.25, SD = 7.72 vs. M = 21.07,
SD = 6.66, p < .001), Table3.
e students in the index group also reported having
significantly poorer health on all subscales of the TSCC
than those in the reference group (all p < .001), Table3.
Table4 shows a more detailed description of the TSCC
results. e students that had been sexually abused
both online and offline scored higher than those abused
only online, but the difference only reached significance
on the subscale depression (M = 13.29, SD = 6.65 vs.
8.33, SD. = 7.43, p = .008). e index group scored gen-
erally higher on all scales than students abused outside
the internet, but there were no statistically significant
differences.
Risk behaviors, internet use andpornography
consumption
Table5 shows that the index group students reported
significantly different online behaviors than those in the
reference group. e difference was not significant with
respect to time spent online but was significant with
respect to what was being engaged in online. All of the
following behaviors were more common in the index
group than in the reference group: had more often
during the preceding year shared contact information
(43.8% vs. 12.0%, p < .001), looked for someone to talk
sex with (38.7% vs. 3.8% %, p < .001) or had sex with
(35.5% vs. 3.5%, p < .001), sent nude pictures (71.9% vs.
24.4%, p < .001) and posted nude pictures on a commu-
nity or internet site (25% vs. 1.9%, p < .001). ey also
had been offended far more often by crude sexual lan-
guage online (28.1% vs. 3.8%, p < .001).
e experience of having ever used drugs was more
common in the index group (48.4% vs. 23.3%, p < .001)
but alcohol consumption did not differ between the
index group and the reference group. ere were no
significant differences between the groups in relation
to age of sexual debut, number of sexual partners, or
extent of consumption of pornography.
Table 3 Online sexual abuse—parental bonding (PBI),
self-esteem (Rosenberg) andtrauma symptoms (TSCC)
a p-value based on Mann–Whitney U-test
Not sexually
abused
ontheinternet
N = 5499–5659
Sexually abused
ontheinternet
N = 31–32
p-valuea
M SD M SD p
PBI
Mother care 30.02 6.29 26.19 7.71 .002
Father care 27.88 7.43 21.10 7.58 < .001
Mother overprotection 11.69 6.82 16.32 7.72 .001
Father overprotection 10.60 6.63 16.26 7.09 < .001
Rosenberg 21.07 6.66 15.25 7.72 < .001
TSCC
Anxiety 4.68 3.98 8.38 5.87 < .001
Depression 5.14 4.52 10.97 6.96 < .001
Anger 4.12 4.07 7.97 5.88 < .001
Posttraumatic stress 6.19 5.06 11.78 7.18 < .001
Dissociation 5.98 4.87 10.84 6.83 < .001
Sexual concern 2.23 2.48 4.72 3.98 < .001
Critical items 1.71 2.51 5.41 5.04 < .001
Total score 29.47 20.68 56.03 32.89 < .001
Table 4 Detailed description oftrauma symptoms (TSCC) amongadolescents sexually abused (SA) online andoine
No SA (a)
N = 4185–4223 SA onlyouside
theinternet (b)
N = 1073–1091
SA onlyonthe
internet (c)
N = 15
SA
bothoutsideand
ontheinternet (d)
N = 17
Stat sign
M SD M SD M SD M SD One way ANOVA withBonferroni correction
TSCC
Anxiety 4.20 3.63 6.82 4.53 7.20 6.38 9.41 5.35 a/b .000, a/c .015, a/d .000, b/c ns, b/d .035, c/d ns
Depression 4.61 4.14 7.59 5.14 8.33 6.54 13.29 6.65 a/b.000, a/c .006, a/d .000, b/c ns, b/d .000, c/d .008
Anger 3.75 3.86 5.74 4.57 8.40 7.00 7.59 4.89 a/b .000, a/c .000, a/d .001, b/c ns, b/d ns, c/d ns
Posttraumatic stress 5.50 4.57 9.26 5.82 9.87 6.60 13.47 7.43 a/b .000, a/c .003, a/d .000, b/c ns, b/d .002, c/d ns
Dissociation 5.48 4.55 8.29 5.45 8.53 6.83 12.88 6.33 a/b .000, a/c ns, a/d .000, b/c ns, b/d .000, c/d ns
Sexual 2.02 2.35 3.10 2.77 4.80 4.90 4.65 3.10 a/b .000, a/c .000, a/d .000, b/c .045 b/d ns, c/d ns
Critical items 1.37 2.20 3.12 3.12 4.53 5.91 6.18 4.16 a/b .000, a/c .000, a/d .000, b/c ns, b/d .000, c/d ns
Total 26.80 18.91 41.44 23.13 49.07 37.62 62.18 27.78 a/b .000, a/c .000, a/d .000, b/c ns, b/d .000, c/d ns
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Jonssonetal. Child Adolesc Psychiatry Ment Health (2019) 13:32
Multiple logistic regression analyses
Stepwise multiple logistic regression analyses for
Tables 1, 2, 3 and 5, 6 separately revealed 11 variables
that could be analyzed to produce a final model with five
variables, Table6. In the final model experiences of abuse
such as penetrative sexual abuse (OR 3.68, CI 1.58–8.58)
and threats of being hit (OR 2.33, CI 1.04–5.24) were sig-
nificantly associated with being sexually abused online.
Risky internet behavior such as looking for someone
online to talk sex with (OR 6.52, CI 2.73–15.57) and post-
ing nude pictures on a community or internet site (OR
4.74, CI 1.70–13.16) were also highly associated with
having been sexually abused online. Finally, the subscale
depression was also significantly associated with being
sexually abused online (OR 1.11, CI 1.04–1.17).
Discussion
To our knowledge, this study is the first to study adoles-
cents with experiences of online sexual abuse by a person
they had met online and where they had felt persuaded,
pressed or coerced. e results of the study can be sum-
marized in four main findings.
First, the study showed that most sexual contacts
online were positive experiences with persons of about
Table 5 Online sexual abuse—risk behaviors, internet behavior andpornography consumption
a p-value based on Chi square or Fisher’s exact test
b p-value based on Mann–Whitney’s U-test
Not sexually abused ontheinternet
n = 5498–5663 Sexually abused ontheinternet
n = 31–32 p-valuea
n % n % p
Alcohol use last year
Drink 2–3 times or more per month 1944 34.2 11 34.4 ns
Drug use ever
Ever used drugs, including cannabis 1316 23.3 15 48.4 .001
Sexual debut (mean age/SD) 15.55/2.50 15.78/1.78 nsb
Number of sexual partners
≥ 6 partners 950 25.5 9 37.5 ns
Time spent per day
Computer/tablet ≥ 5 h 1275 22.2 9 28.1 ns
Social media ≥ 5 h 839 14.8 9 28.1 .035
Mobile phone ≥ 5 h 1813 32.0 13 40.6 ns
Internet behavior last year
Shared your e-mail, telephone number or address to someone you only knew through the internet
Yes, several times 682 12.0 14 43.8 < .001
Looked for someone online to talk, sex with
Yes, several times 215 3.8 12 38.7 < .001
Looked for someone online to have sex with
Yes, several times 200 3.5 11 35.5 < .001
Been offended by crude sexual language when you chatted with a person you only knew through the internet
Yes, several times 212 3.8 9 28.1 < .001
Sent nude pictures 1385 24.4 23 71.9 < .001
Posted nude pictures (community/internet site) 109 1.9 8 25.0 < .001
Pornography
Have you ever looked at pornography
Ye s 3865 68.1 23 71.9 ns
Have often have you looked at pornography the last 12 months ns
Not at all 34 0.9 0 0.0
1–2 times 1131 29.3 3 13.0
Sometimes each month 898 23.2 9 39.1
Sometimes each week 1196 30.9 9 39.1
More or less daily 606 15.7 2 8.7
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Jonssonetal. Child Adolesc Psychiatry Ment Health (2019) 13:32
the same age or only slightly older. However, previous
studies have shown that having a sexual relationship with
a person met online can be viewed as a risk behavior
since this kind of contact increases the risk of facing neg-
ative consequences later, for example receiving unwanted
sexual approaches [12]. Similar reasoning has been put
forward by Baumgartner etal. [14, 26] in defining online
sexual risk behaviors as the exchange of intimate sexually
insinuating information and material with someone only
known online. In the current study, 5.8% of the adoles-
cents had had sexual experiences online with a person
they had only met online, and of those, 9.7% reported
that they had been persuaded, pressed or coerced mean-
ing that they, by definition, had been sexually abused
online. Girls were more often the victims and for girls,
the perpetrators were generally older.
Second, there were no significant differences in socio-
demographic background between the index group and
the reference group. is result can be compared to stud-
ies on children victims of online grooming [13] or adoles-
cents sending nude images [5] were it was also found that
the socio-demographic background did not differ from
children without these experiences.
ird, the adolescent victims of online sexual abuse had
backgrounds with significantly more numerous and/or
varied experiences of different forms of abuse including
physical, psychological as well as sexual abuse, especially
penetrative sexual abuse than those who had not been
victims of online sexual abuse. Earlier findings indicate
that the more severe the form of sexual abuse the more
serious the subsequent associated health issues will be,
with penetrating child sexual abuse at the upper end of
the scale of severity [27]. is study underlines these ear-
lier findings but also adds to our knowledge that online
abuse per se is also associated with poor health, low self
esteem and a poorer relationship between parent and
child. As concerns health, as measured by TSCC, online
sexual abuse only was associated with poorer health, at
least on the same level as offline sexual abuse only, with
those students who had been sexually abused both online
and offline scoring highest, supporting the polyvictimiza-
tion model [28].
These results are also supported by earlier studies
[15, 16, 29–31] stating that online sexual victimiza-
tion, also including cyberbullying, are associated with
adverse emotional and psychological consequences. In
the current study, the final multiple logistic regression
model showed that online sexual abuse was strongly
associated with depression. This is in line with the
results from studies focusing on youth who had sent
sexual pictures (sexted), where both Van Ouystel etal.
[32] and Dake etal. [33] found an association between
sexting and depression. In the study by Temple etal.
[34] associations were also found between sexting and
depression in their unadjusted models, but not when
prior sexual behavior, age, gender, race, ethnicity,
Table 6 Online sexual abuse—forward StepWise logistic regression toidentify important variables amongeach block
ofvariables
Variables to be included in a “nal model” was reduced by performing stepwise multiple logistic regression analyses for each table separately
Block Variables identied asstatistically signicant withineach block OR (95% CI)
Table 2a Family financial situation
Poor 1.78 (.78–4.02)
Don’t know 3.53 (1.04–11.95)
Table 2b Any sexual abuse 2.64 (1.02–6.18)
Penetrative sexual abuse 2.76 (1.02–7.50)
Threats of hitting 3.60 (1.68–7.23)
Table 3PBI overprotection, father 1.07 (1.02–1.12)
TSCC depression 1.15 (1.06–1.26)
TSCC sexual anxiety 1.35 (1.14–1.61)
Table 5Looked for someone online to talk sex with 4.80 (1.66–13.88)
Been offended by crude sexual language when you chatted with a person you only knew
through the internet 5.12 (1.78–14.67)
Posted nude pictures (community/internet site) 5.05 (1.60–15.87)
Final model Penetrative sexual abuse 3.68 (1.58–8.58)
Threats of hitting 2.33 (1.04–5.24)
TSCC depression 1.11 (1.04–1.17)
Looked for someone online to talk sex with 6.52 (2.73–15.57)
Posted nude pictures (community) 4.74 (1.70–13.16)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 9 of 10
Jonssonetal. Child Adolesc Psychiatry Ment Health (2019) 13:32
and parental education had been adjusted for. It is,
however, important to bear in mind that the studies
referred to above do not examine if the motivation
factor for sending the images was, for example, send-
ing the image just for fun and with no negative con-
sequences afterwards or if it was because of coercion
leading to the taking and sending of the image.
Fourth, adolescents abused online also had more
online risk behaviors such as sharing personal infor-
mation significantly more often, looking for someone
online to talk sex with, or posting nude pictures on a
community site. These behaviors might increase the
risks of later being a victim of online sexual abuse [17].
The results in the study should be read in light of
the following limitations. The response rate was rather
low at 59.7%. Part of this can be explained by the fact
that on a typical day 10% of students of this age are
absent from school. An assumption is that the absent
group probably would have added some individuals
to the index group and thereby affected the results
slightly, since people dropping out from research more
often come from families with poorer support and are
more often burdened with psychosocial health issues
and lower motivation to participate in school surveys
[35]. On the other hand, other studies that have found
little evidence for substantial bias as a result of non-
participation [36]. Recall bias is always a limitation
in questionnaire-based studies, as is the question of
whether the answers are trustworthy. All answers were
reviewed before the analyses and 34 questionnaires
were excluded due to unserious answers. Another
limitation is the small size of the index group which
may cause low statistical power. The main concern
regarding study power arises when the index group
is separated into two groups. When comparing these
two groups to the reference group, statistical signifi-
cance is detected, even though the power is well below
80%. However, in all but one comparison between the
two subgroups (SA internet, SA offline and internet)
no statistical difference was detected. Having a larger
power would probably result in more statistically sig-
nificant findings. The implication of the low power is
that we underestimate rather than overestimate the
presence of actual differences between the groups.
Finally, the index question did not contribute to any
additional probing to determine what online sexual
activities or sexual abusive behaviors respondents
might be referring to when they endorsed these items,
nor did it allow them to describe the behavior further.
It would have been conceptually interesting to have a
fuller description and examples from respondents.
Conclusions
e socio-demographic background of the adolescent
victims of online sexual abuse in the current study did
not differ from the background of adolescents without
this experience, but significant differences were found
in relation to their prior experience of different forms
of abuse indicating that they belong to a polyvictim-
ized group. Together with risky online behavior, the
poorer psychological health in combination with poor
relationships with parents and low self-esteem might
increase the vulnerability of these individuals to having
sexual contact online and having that contact with peo-
ple unknown to them who might then abuse them. It is
also plausible to think that poorer health can be a con-
sequence of the abusive online experiences but also the
other way around since we can’t establish the causality
in this kind of cross-sectional study. e study demon-
strates the importance of viewing online sexual abuse
as a serious form of sexual abuse even if the victim and
perpetrator have not met outside the internet. Profes-
sionals meeting these children need not only to focus
on their psychological health as indicated by symp-
toms of trauma and depression but also must screen for
online behavior, online abuse and other forms of previ-
ous abuse.
Acknowledgements
The authors would like to thank the Swedish Ministry of Health and Social
Affairs, Children’s Welfare Foundation Sweden and the Swedbank Scientific
Research Foundation.
Authors’ contributions
All authors contributed in the design of the study and the data collection. LSJ
and CGS analysed the data and LSJ wrote the manuscript. CGS, CF, MW and GP
commented on the work. All authors read and approved the final manuscript.
Funding
The study was funded by the Swedish Ministry of Health and Social Affairs and
the Swedbank Scientific Research Foundation.
Availability of data and materials
Not applicable.
Ethics approval and consent to participate
The study was approved by the Regional Ethical Review Board of Linköping,
Sweden (Dnr, 131-31). All participants consented to attend the study by
answering the questionnaire.
Consent for publication
All authors have given their consent for publication.
Competing interests
The authors declare that they have no competing interests.
Author details
1 Barnafrid, Child and Adolescent Psychiatry, Department of Clinical and Exper-
imental Medicine, Faculty of Medicine, Linköping University, 581 83 Linköping,
Sweden. 2 Child and Adolescent Psychiatry, Department of Clinical and Experi-
mental Medicine, Faculty of Medicine, Linköping University, 581 85 Linköping,
Sweden. 3 Department of Psychology, Lund University, 221 00 Lund, Sweden.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 10 of 10
Jonssonetal. Child Adolesc Psychiatry Ment Health (2019) 13:32
Received: 11 April 2019 Accepted: 16 August 2019
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