ArticlePDF Available

A Global Perspective on Child Sexual Abuse: Meta-Analysis of Prevalence Around the World

May 2011
Child Maltreatment 16(2):79-101

DOI:10.1177/1077559511403920

Source
PubMed

Authors:

Marije Stoltenborgh

Erasmus University Rotterdam

Marinus H. van IJzendoorn

University College London

Marian bakermans-kranenburg

ISPA - Instituto Universitário

Our comprehensive meta-analysis combined prevalence figures of childhood sexual abuse (CSA) reported in 217 publications published between 1980 and 2008, including 331 independent samples with a total of 9,911,748 participants. The overall estimated CSA prevalence was 127/1000 in self-report studies and 4/1000 in informant studies. Self-reported CSA was more common among female (180/1000) than among male participants (76/1000). Lowest rates for both girls (113/1000) and boys (41/1000) were found in Asia, and highest rates were found for girls in Australia (215/1000) and for boys in Africa (193/1000). The results of our meta-analysis confirm that CSA is a global problem of considerable extent, but also show that methodological issues drastically influence the self-reported prevalence of CSA.

Estimated combined prevalence for self-report studies of CSA, separated according to geographical area of origin of the sample and to gender, including the overall combined prevalence for girls and boys. Stars represent a significant difference between girls and boys within a geographical area of origin of the sample (*p < .05; **p < .01). a The significance of the analyses on the South American samples could not be tested, due to k < 4.

…

Results of Moderator Analyses for Self-Report Studies: Number of Studies and Participants, and Combined Prevalence Including 95% Confidence Intervals (CI)

…

continued)

…

Figures - uploaded by Marinus H. van IJzendoorn

Content may be subject to copyright.

Content uploaded by Marinus H. van IJzendoorn

Content may be subject to copyright.

http://cmx.sagepub.com/

Child Maltreatment

http://cmx.sagepub.com/content/16/2/79

The online version of this article can be found at:

DOI: 10.1177/1077559511403920

2011 16: 79 originally published online 21 April 2011Child Maltreat

Marije Stoltenborgh, Marinus H. van IJzendoorn, Eveline M. Euser and Marian J. Bakermans-Kranenburg

A Global Perspective on Child Sexual Abuse: Meta-Analysis of Prevalence Around the World

Published by:

http://www.sagepublications.com

On behalf of:

American Professional Society on the Abuse of Children

can be found at:Child MaltreatmentAdditional services and information for

http://cmx.sagepub.com/cgi/alertsEmail Alerts:

http://cmx.sagepub.com/subscriptionsSubscriptions:

http://www.sagepub.com/journalsReprints.navReprints:

http://www.sagepub.com/journalsPermissions.navPermissions:

http://cmx.sagepub.com/content/16/2/79.refs.htmlCitations:

What is This?

- Apr 21, 2011 OnlineFirst Version of Record

- May 9, 2011Version of Record >>

by guest on February 19, 2013cmx.sagepub.comDownloaded from

A Global Perspective on Child

Sexual Abuse: Meta-Analysis of

Prevalence Around the World

Marije Stoltenborgh

, Marinus H. van IJzendoorn

Eveline M. Euser

, and Marian J. Bakermans-Kranenburg

Abstract

Our comprehensive meta-analysis combined prevalence figures of childhood sexual abuse (CSA) reported in 217 publications

published between 1980 and 2008, including 331 independent samples with a total of 9,911,748 participants. The overall estimated

CSA prevalence was 127/1000 in self-report studies and 4/1000 in informant studies. Self-reported CSA was more common

among female (180/1000) than among male participants (76/1000). Lowest rates for both girls (113/1000) and boys (41/1000)

were found in Asia, and highest rates were found for girls in Australia (215/1000) and for boys in Africa (193/1000). The results

of our meta-analysis confirm that CSA is a global problem of considerable extent, but also show that methodological issues dras-

tically influence the self-reported prevalence of CSA.

Keywords

child sexual abuse, epidemiology, gender/sex differences, community samples, adult retrospective reports, cultural/ethnic issues

There is no question about the negative effects of child sexual

abuse (CSA) on children’s psychological well-being and their

development into adulthood. CSA is associated with a variety

of problems in the short and the long term for both male and

female victims (Beitchman, Zucker, Hood, Dacosta, & Akman,

1991; Beitchman et al., 1992; Browne & Finkelhor, 1986;

Chapman et al., 2004; Jumper, 1995; Kendall Tackett, Williams,

& Finkelhor, 1993; Paolucci, Genuis, & Violato, 2001; Romano

& De Luca, 2001; Spatz Widom, Czaja, & Dutton, 2008; Spatz

Widom, DuMont, & Czaja, 2007). Although there seems to be

some consensus on the global and persistent occurrence of CSA,

controversy exists as to the overall prevalence of CSA with rates

varying from 0.1%(Mackenzie, Blaney, Chivers, & Vincent,

1993) to 71.0%(Everill & Waller, 1995). We conducted a com-

prehensive meta-analysis of 217 publications on CSA published

from 1982 to 2008, including 331 independent samples with a

total of 9,911,748 participants, aiming to reveal the extent of the

problem and to examine the influence of geographical and sam-

ple characteristics as well as procedural factors on the estimated

prevalence of CSA.

Influence of Geographical and Sample Characteristics

Higher prevalences of CSA among girls than among boys are

consistently found (Finkelhor & Baron, 1986; Finkelhor,

1994; Pereda, Guilera, Forns, & Gomez-Benito, 2009a; Pereda,

Guilera, Forns, & Gomez-Benito, 2009b; Putnam, 2003;

Rind, Tromovitch, & Bauserman, 1998). Besides gender, the

geographical origin of the samples may influence prevalence.

Although geographical area and culture are not isomorphic,

differences in cultural beliefs and values might be the underlying

mechanism affecting the estimated prevalence of CSA across

countries and continents (Kenny & McEachern, 2000b). For

example, in collectivist cultures like the Asians the needs of a

group tend be considered somewhat more important than those

of an individual (Hofstede, 2001). This might result in ignoring

the abuse experiences of an individual family member in order to

protect the family from the shame associated with a reported

case of abuse (Back et al., 2003). Also, cultural differences with

regard to sexuality and to sexual restraint might influence the

prevalence of sexual abuse and/or the willingness of sexual

abuse victims to disclose their experiences (Kenny & McEachern,

2000b; Runyan, 1998). Examples are thetaboo around girls losing

their virginity before marriage andthe taboo on boys’ homosexual

experiences that are often found in Hispanic cultures (Kenny &

McEachern, 2000b).

Despite the fact that the body of international research about

sexual abuse has widely expanded since Finkelhor (1994)

Centre for Child and Family Studies, Leiden University, Leiden, The

Netherlands

Corresponding Author:

Marinus H. van IJzendoorn, Centre for Child and Family Studies, Leiden

University, PO Box 9555, 2300 RB Leiden, The Netherlands

Email: vanijzen@fsw.leidenuniv.nl

Child Maltreatment

16(2) 79-101

ªThe Author(s) 2011

Reprints and permission:

sagepub.com/journalsPermissions.nav

DOI: 10.1177/1077559511403920

http://cm.sagepub.com

by guest on February 19, 2013cmx.sagepub.comDownloaded from

called for more prevalence studies, not much research

has compared prevalence rates among countries or conti-

nents. One meta-analysis reported that the highest preva-

lence rates were found in Africa and the lowest in Europe

(Pereda et al., 2009b). A clue as to what to expect might also

come from studies comparing different ethnic groups in

predominantly Caucasian countries like the United States.

In this type of study, Asian minorities often show lower

prevalence rates whereas Hispanic minorities often show

higher prevalence rates compared to Caucasians (Kenny &

McEachern, 2000b). Findings are not unequivocal, however,

and it remains to be seen whether the pattern that is found for

immigrant groups also emerges from comparisons among

continents.

Procedural Factors

Sampling has been identified more than once as contributing to

the diversity in CSA prevalence rates (Goldman & Padayachi,

2000; Wyatt & Peters, 1986). It has been argued that lower pre-

valence rates are found in convenience samples such as college

student samples that are widely used for research on CSA, com-

pared to random samples representing the wider community

(Goldman & Padayachi, 2000). A possible reason for the lower

prevalence in college samples is that they may be a psycholo-

gically healthier group (Goldman & Padayachi, 2000). CSA

is found to be related to adverse psychological adjustment

(Jumper, 1995) and as such, better psychological health may

be associated with lower CSA prevalence. College students

may also be more aware of the study’s aims and thus more

liable to response biases.

Studies on CSA also differ in the method of data

collection. Studies in which children or adults report on their

own CSA experiences mainly use interviews and question-

naires. Whether or not differences between these two data

collection methods are related to differences in prevalence

rates of CSA remains unclear. Some reviews have noted that

studies using interviews show higher prevalence rates than

those using questionnaires (Pereda et al., 2009a; Wyatt &

Peters, 1986) while others did not report such a difference

(Goldman & Padayachi, 2000; Pereda et al., 2009b; Wyatt

& Peters, 1986). It should be noted that both interviews and

questionnaires are based on self-reported retrospective recol-

lection (Fergusson & Mullen, 1999), with some uncertainty

about whether the reported experiences actually took place

(Goldman & Padayachi, 2000), although according to Koss

(1993) it is widely accepted that the underreporting of rape is

a greater threat to validity than fabrication. Reports of profes-

sionals, dossier or chart reviews, and informant observations

of children such as teachers observing their students in primary

schools, do not rely on potentially biased memories of the

respondents and document child abuse from the view of a trained

observer or expert. A possible drawback of such informant stud-

ies is that CSA may be difficult to be detected by informants

because CSA might be less ‘‘visible’’ to outsiders than other

types of abuse.

Incidence and Prevalence

For the difference between studies using self-report measures

of CSA and informant studies the distinction between inci-

dence and prevalence rates might be of interest. Prevalence

refers to the number of individuals having experienced sexual

abuse during childhood (Fallon et al., 2010; Peters, Wyatt, &

Finkelhor, 1986). Life-time prevalences are generally assessed

in self-report studies, since participants are usually asked to

report on their experiences of abuse during their entire child-

hood and adolescence. Incidence, on the other hand, refers to

the number of new cases of abuse reported or detected during

a specific, restricted period of time (Fallon et al., 2010; Peters

et al., 1986), often in the context of child protective services.

Incidence studies may underestimate the occurrence of CSA

(Leventhal, 1998) because only a small proportion of abuse

cases may be reported to child protective services or other

authorities (Goldman & Padayachi, 2000; Leventhal, 1998;

Peters, Wyatt, & Finkelhor, 1986). Moreover, incidence studies

capture fewer CSA experiences than prevalence studies

because the time frame of incidence studies is more limited

than the life-time reports in prevalence studies.

However, with regard to studies of CSA based on informants

(in combination with child protective services files) the distinc-

tion between incidence and prevalence may not be as clear-cut

as it seems to be. First, the informants might cover more cases

than those that are officially reported to child protective ser-

vices, certainly in countries without the legal obligation to report

(Euser, Van IJzendoorn, Prinzie, & Bakermans-Kranenburg,

2010). Second, it is impossible to ascertain that the cases

reported by informants in incidence studies are the very first

sexual abuse experiences of a child and therefore incidence

studies of CSA might better be regarded as studies of the

current prevalence of CSA during a limited period of time

(Van IJzendoorn et al., 2007). Based on the above discussion,

prevalence rates from informant studies might underestimate

the prevalence of CSA whereas rates from self-report studies

might have a bias toward overestimation (Van IJzendoorn, 2007).

Defining CSA

In self-report studies, participants are sometimes asked ques-

tions about CSA without specification of experiences or beha-

viors that constitute CSA. The answers to these questions may

be heavily influenced by the participants’ subjective percep-

tions and definitions of CSA. An extreme example is ‘‘Have

you been sexually abused?’’ (e.g., Diaz, Simantov, & Rickert,

2002; Hibbard, Ingersoll, & Orr, 1990). This type of question

does not include a clear operationalization of CSA as presented

by the researcher. How CSA is defined and subsequently oper-

ationalized might have an impact on the reported prevalence.

Of course, this is true for both self-report and informant studies.

A definition of CSA includes several aspects. Defining the cut-

off age for childhood is an important factor, as is the decision

whether or not to define a minimum age difference between

victim and perpetrator to rule out sexual activity among peers.

80 Child Maltreatment 16(2)

by guest on February 19, 2013cmx.sagepub.comDownloaded from

Moreover, the acts that constitute CSA are a crucial criterion

that could influence the reported CSA prevalence. It is easy

to imagine that including, for example, noncontact abuse such

as sexual propositions and exhibitionism would yield higher

prevalence rates than including contact abuse only. However,

Pereda et al. (2009b) found no difference in combined preva-

lence rates between their broad definition (including noncontact

CSA) and their narrow definition (including contact CSA only).

According to these authors, this puzzling finding is due to the

inclusion of some experiences in both their broad definition and

their narrow definition. Related to this issue, the number of ques-

tions asked in order to assess CSA may affect the prevalence

estimates to some extent because multiple questions can include

more specific information about the definition ofCSA than a sin-

gle questions can, and more questions might also cover more

aspects of CSA, and thus lead to higher prevalence rates.

This Study

The current meta-analysis aims at providing an estimate of the

world-wide prevalence of CSA by integrating prevalence figures

from a large body of research on CSA and its correlates. We

focused on unraveling the substantial variation in prevalence fig-

ures reported in primary studies by analyzing the effects of geo-

graphical and sample characteristics and of procedural factors on

combined prevalence rates. It is crucial to know whether design

and measurement differences between prevalence studies partly

or largely determine the outcomes. Meta-analyses might help to

identify the set of studies with optimal design features for com-

parison across time and cultures.

We replicated and extended a previous meta-analysis on the

same subject (Pereda et al., 2009b) by including a considerably

larger number of studies (331 studies in our meta-analysis ver-

sus 100 in Pereda et al., 2009b) and a larger number of modera-

tors. A larger number of studies has several advantages. It

increases the power of the analyses, which is important for the

detection of smaller effect sizes and imperative in case of meth-

odological heterogeneity of the studies included in the analyses

(Valentine, Pigott, & Rothstein, 2010). Furthermore, the larger

number of studies allows us to test the influence of moderators

on estimates of prevalence rates separately for girls and boys,

which was not done by Pereda et al. (2009b). CSA experiences

of boys and girls show considerable divergence in prevalence

and consequences.

Another important difference between Pereda et al. (2009b)

and our meta-analysis is that Pereda et al. (2009b) included only

self-report studies whereas we also included informant studies

using reports of professionals. Exploring potential differences

in prevalence estimates resulting from these rather different

approaches is important because policy decisions regarding

several aspects of (the prevention of) CSA are often based on

government initiated informant studies such as the National Inci-

dence Study of Child Abuse and Neglect (NIS; Sedlak, 2001) in

the United States, the Canadian Incidence Study of Reported

Child Maltreatment (CIS; Trocme´, Tourigny, MacLaurin, &

Fallon, 2003) in Canada, and the Nationale Prevalentiestudie

Mishandeling van Kinderen en Jeugdigen (NPM; Van IJzendoorn

et al., 2007) in the Netherlands. We expected prevalence rates

to be higher for self-report studies than for informant studies, in

which case policy decisions might be based on a possible

underestimate of CSA prevalence if we have reason to suspect

that self-reported prevalences wouldbeclosertothetrueratein

the population.

We also expected combined rates to be higher for girls than

for boys, and higher for studies using a more inclusive defini-

tion of CSA compared to studies using a more exclusive defi-

nition of CSA. Since previous results were inconclusive with

regard to the influence on CSA prevalence of geographical area

of origin of the sample, the method of sampling, and the

method of data collection, analyses on these moderator vari-

ables were exploratory.

Method

Literature Search

Three search methods were used to identify eligible studies,

published between January 1980 and January 2008. First, we

searched the electronic databases PubMed, Online Contents,

Picarta, ERIC, PsychInfo, and Web of Science for empirical

articles using the terms prevalence and/or incidence

combined with one of the following terms: (child*) (sexual)

maltreatment, (sexual) abuse, and victimization. Second, we

electronically searched the specialized journals Child Abuse

and Neglect and Child Maltreatment with the same terms as

mentioned above. Third, the references of the collected arti-

cles, dissertations, and book chapters were searched for rele-

vant studies, as were other reviews and meta-analyses on child

sexual abuse (CSA). Studies were included if the prevalence

of CSA was reported (a) in terms of proportions at child level

(excluding studies only reporting estimates of the family

level) (b) for victims under the age of 18 years in (c) noncli-

nical samples, and (d) if sufficient data were provided to

determine this proportion as well as the sample size.

If publications reported on the same sample or on

overlapping samples, the publication providing the maximum

of information was included in the meta-analysis. Thus, the

independence of samples and the inclusion of every participant

only once in the pertinent meta-analysis were ascertained.

When possible and necessary, the coding form (Table 1) for

the study was supplemented with information from the

other—excluded—publications on the same sample. When a

publication reported the prevalence of CSA for more than one

sample separately, for example, for male and female partici-

pants or for participants of different ethnicities, these subsam-

ples were treated as independent studies. This procedure

yielded 217 publications, published from 1982 to 2008, cov-

ering a total of 331 samples.

Data Extraction

We coded three types of moderators: sample characteristics, pro-

cedural moderators, and publication moderators (see Table 1).

Stoltenborgh et al. 81

by guest on February 19, 2013cmx.sagepub.comDownloaded from

Table 1. Coding System

Variable Coding Description

Sample characteristics

Continent 1 Australia Including New Zealand

2 North America Including USA and Canada

3 Europe

4 Africa

5 South America

6 Asia

Country’s level of economic

development

1 Developing

2 Developed

Ethnicity 1 African American Predominance in sample, based on

reports in the study

2 Caucasian

3 Asian

4 Hispanic

5 African

Age of respondent at assessment Continuous

Gender distribution in sample 1 Male

2 Female

3 Mixed

Procedural moderators

Definition of abuse 1 According to NIS-3 Based on the types of behavior

included in the definition2 Broader than NIS-3

3 Stricter than NIS-3

Prevalence period 1 0–12 Age criterion that was used to define

CSA; each participant was

included in a single category

2 0–13

3 0–14

4 0–15

5 0–16

6 0–17

7 0–18

8 Limited period: 1 year

9 Limited period > 1 year

Age difference 1 Difference specified The minimum age difference between

victim and perpetrator in the def-

inition of CSA

2 No difference specified

Type of instrument 1 Questionnaire

2 Interview face-to-face

3 Telephone interview

4 Computerized interview

5 Observation

6 Reports of professionals

7 Dossier or chart study

Instrument validated 1 No

2 Yes

Number of questions regarding CSA Continuous; if a range was provided,

the minimum number was coded

Respondent 1 Child or adolescent

2 Parent

3 Adult

Response rate Continuous

Sampling procedure 1 Random

2 Modified random

3 Convenience sample

Sample size Continuous

Evidence maltreatment 1 Self-report Self-report was coded when parents

were respondents

2 Informant

Publication moderators

Year of publication Continuous

Publication outlet 1 Journal article

2 Dissertation

3 Book chapter

Note: CSA ¼childhood sexual abuse.

82 Child Maltreatment 16(2)

by guest on February 19, 2013cmx.sagepub.comDownloaded from

Sample characteristics comprised the geographical area from

which the sample originated (Australia/New Zealand, North

America, Europe, Africa, South America, Asia), the level of

economic development of the sample’s country of origin (high-

resource or low-resource according to the World Economic

Outlook Database [International Monetary Fund, 2010]), the

predominant ethnicity of the sample (only used for the subset

of studies originating from the United States and Canada), the

age of the respondent at the time of assessment (recoded into

three categories using the 33rd and 67th percentile scores: <20

years, 20–30 years, >30 years), and the gender distribution in the

sample (100%female, 100%male, or mixed). The coded out-

come was the proportion of children sexually abused. In order

to be able to weight effect sizes, sample size was also coded.

Procedural moderators included the definition of CSA that

was coded in accordance with the acts of perpetrators covered

by the definition used by the third National Incidence Study

(Sedlak, 2001; see Appendix). This resulted in three categories

ranging from stricter to broader than the NIS-3 definition.

When the definition of CSA included a smaller set of indicators

than specified in the Appendix (in most cases, implying indica-

tors restricted to penetration), ‘‘stricter than NIS-3’’ was coded.

When no more and no less than the perpetrator acts specified in

the appendix were included in a study’s definition of CSA,

‘‘according to NIS-3’’ was coded. ‘‘Broader than NIS-3’’ was

coded when noncontact abuse (such as exhibitionism) was

included in the study’s CSA definition.

Furthermore, procedural moderators included the period of

prevalence (0–12, 0–13, 0–14, 0–15, 0–16, 0–17, 0–18, limited

period 1 year, limited period >1 year; each participant was

included in a single category), and whether the definition of

CSA in the study included the specification of an age difference

between victim and perpetrator (difference specified, no differ-

ence specified). Procedural moderators regarding the measure-

ment of CSA were the type of instrument used for the study

(questionnaire, face-to-face interview, telephone interview,

computerized interview, observation, reports of professionals,

dossier/chart study), whether the instrument was validated (as

reported by the studies; yes or no), and the number of questions

asked (recoded into three categories using the 33rd and 67th

percentile scores: less than 3, 3–7, 8 or more). Other procedural

moderators included who the respondent was in the case of self-

report (children/adolescents, adults, parents), the response rate

(recoded into three categories using the 33rd and 67th percentile

scores: low [<66.8%], medium [66.8–85.2%], high [>85.2%]),

the sampling procedure (randomized—including random and

modified random samples—, convenience, or other), the sample

size (recoded into three categories using the 33rd and 67th per-

centile scores: small [<265], medium [265–733], large [>733]),

and the kind of evidence used to determine CSA (self-report—

scored also when parents reported on abuse of their children—

vs. informant, based on clinical judgment, medical evaluation,

or jurisprudence).

Publication moderators were publication outlet (journal

article, dissertation, book chapter, other) and year of publica-

tion (recoded into decades). To assess intercoder reliability,

30 publications were coded by two coders. Agreement between

the coders for moderators and outcome variables was satisfac-

tory (ks for categorical variables between .52 and 1.00, average

.78, and agreement between 65 and 100%, average 86%; intra-

class correlations for continuous variables between .78 and

1.00, average .95; lowest interrater agreement for period of pre-

valence, complete agreement for continent,economic develop-

ment,ethnicity,age respondent,gender,sample size,evidence,

year of publication,publication outlet).

Meta-Analytic Procedures

Meta-analytical approaches are well-known in medical sci-

ence, for example, to test the effectiveness of an intervention

on a disease. This type of research question requires methodo-

logical homogeneity of the studies included that ideally should

be randomized controlled trials. In contrast, our meta-analysis

included studies that were heterogeneous in their methodology,

and one of our aims was to explore the possible influence of

methodological factors on reported prevalence. This type of

approach has been used earlier in other meta-analyses aiming

at estimating prevalence (e.g., De Sanjose et al., 2007; Pereda

et al., 2009b; Van Os, Linscott, Myin-Germeys, Delespaul, &

Krabbendam, 2009), as well as in many meta-analyses on non-

experimental, correlational studies in human development

(e.g., Barel, Van IJzendoorn, Sagi-Schwartz, & Bakermans-

Kranenburg, 2010; Cyr, Euser, Bakermans-Kranenburg, & Van

IJzendoorn, 2010; Juffer, & Van IJzendoorn, 2005).

The meta-analysis was performed using the Comprehen-

sive Meta-Analysis (CMA) program (Borenstein, Rothstein,

& Cohen, 2005). For each study, the proportion of abused

children was transformed into a logit event rate effect size and

the corresponding standard error was calculated (Lipsey &

Wilson, 2001). After the analyses, the logits were retrans-

formed into proportions to facilitate interpretation of the

results. Combined effect sizes were computed using CMA.

Analyses were carried out both including and excluding

outlying logit event rates and including and excluding multi-

variate outlying studies. Multivariate outliers were detected

after multiple imputation of missing values, using the missing

values analysis in SPSS 17.0. Because no significant differ-

ences were found between analyses including and excluding

outliers, results are reported including outliers.

Significance tests and moderator analyses were performed

through random effects models (Borenstein, Hedges, &

Rothstein, 2007). Fixed effects models are based on the

assumption that effect sizes observed in a study estimate the

corresponding population effect with random error that stems

only from the chance factors associated with subject-level sam-

pling error in that study (Lipsey & Wilson, 2001; Rosenthal,

1991). This assumption is not made in random effects models

(Hedges & Olkin, 1985). Random effects models allow for the

possibility that there are also random differences between stud-

ies that are associated with variations in procedures, measures,

or settings that go beyond subject-level sampling error and thus

point to different study populations (Lipsey & Wilson, 2001).

Stoltenborgh et al. 83

by guest on February 19, 2013cmx.sagepub.comDownloaded from

To test the homogeneity of the overall set and specific sets

of effect sizes, we computed Q-statistics (Borenstein et al.,

2005). In addition, we computed 95%confidence intervals

(CIs), again based on random estimates, around the point esti-

mate of each set of effect sizes. Q-statistics and p-values were

also computed to assess differences between combined effect

sizes for specific subsets of studies grouped by moderators.

Again, the more conservative random effects model tests were

used. Contrasts were only tested when at least two of the sub-

sets consisted of at least four studies (Bakermans-Kranenburg,

van IJzendoorn, & Juffer, 2003).

We used the ‘‘trim and fill’’ method (Duval & Tweedie,

2000a, 2000b) to calculate the effect of potential publication

bias on the outcomes of the meta-analyses. Using this method,

a funnel plot is constructed of each study’s effect size against

its precision (usually plotted as 1/SE). These plots should be

shaped like a funnel if no publication bias is present. However,

since smaller studies and studies with nonsignificant results are

less likely to be published, studies in the bottom left-hand cor-

ner are often omitted (Duval & Tweedie, 2000b; Sutton, Duval,

Tweedie, Abrams, & Jones, 2000). We used the logit of the

reported prevalence as effect size. The kright-most studies con-

sidered to be symmetrically unmatched were trimmed. The

trimmed studies can be replaced and their missing counterparts

imputed or ‘‘filled’’ as mirror images of the trimmed outcomes.

This then allows for the computation of adjusted overall effect

sizes and confidence intervals (Gilbody, Song, Eastwood, &

Sutton, 2000; Sutton et al., 2000).

Results

Combined Prevalence

The combined prevalence for the total set of studies (k¼331,

N¼9,911,748) was 11.8%(95%CI: 10.0–13.8%;p< .01).

The set of studies was heterogeneous, Q(330) ¼269,244.78;

p< .01, indicating that differences among the effect sizes

existed within this set of studies that originate from another

source than sampling error. We conducted a moderator analysis

contrasting self–report studies with studies based on informants,

which was significant, Q(1) ¼30.03; p< .01, reflecting a differ-

ence in combined prevalence between studies using informants

and studies using self-report measures of CSA. The combined

prevalence was 0.4%(95%CI: 0.1–1.5%) for informant studies

(k¼8, N¼9,500,797) and 12.7%(95%CI: 10.7–15.0%)for

self-report studies (k¼323, N¼410,951). The confidence

intervals of informant and self-report studies did not overlap.

Therefore, these sets of studies were treated as representing

separate populations of studies. We report the results of the

moderator analyses for the set of self-report studies only because

moderator analyses were not possible within the set of informant

studies due to the small number of studies.

Duval and Tweedie’s (2000a, 2000b) trim and fill method

revealed no asymmetry in the funnel plots for self-report and

informant studies. The absence of unmatched studies on the right

side suggests that asymmetrical publication bias is unlikely.

Moderator Analyses

The results of all moderator analyses on the set of self-report

prevalence studies are presented in Table 2, in the left-hand

column for girls and in the right-hand column for boys. The

results of the moderator analyses using gender are presented

separately in the next paragraph.

Sample characteristics. The result of the moderator analysis

for gender (female, male, mixed) was significant, Q(2) ¼

105.33; p< .01, as was the result of the analysis contrasting

studies with female and male samples, Q(1) ¼92.63; p<

.01. The combined prevalence for female samples was 18.0%

(95%CI: 16.4–19.7%;p< .01), for male samples 7.6%(95%

CI: 6.6–8.8%;p< .01), and for samples with mixed gender

8.7%(95%CI: 6.5–11.6%;p< .01). Because the confidence

intervals of female and male samples did not overlap, we

decided to conduct further moderator analyses separately for

female and male samples (see Table 2).

Significant differences were found between the continents

of origin of the sample for girls as well as for boys. The highest

combined prevalence was found in Australia for girls and in

Africa for boys whereas the lowest combined prevalence was

found in Asia for both genders. This can also be seen in

Figure 1, representing the results of moderator analyses using

gender, carried out separately for each continent. Significant

gender differences were found in Asia, Australia, Europe, and

United States/Canada, with girls showing a higher combined

prevalence than boys. With respect to the level of economic

development of the sample’s country of origin, significant

differences were found for boys but not for girls. For boys, the

combined prevalence was higher in low-resource countries

than in high-resource countries. When ethnicity was used as a

moderator on the subsample of studies with samples originating

from the United States and Canada, differences between ethnic

groups were found for boys but not for girls. For boys only, the

combined prevalence for African American samples was higher

than for Caucasian samples. No significant differences were

found related to the age of the respondent atthetimeofthe

study, indicating a comparable combined prevalence for studies

using respondents younger than 20-years-old, 20–30-years-old,

and older than 30 years.

Procedural moderators. Figure 2 shows the procedural

moderator analyses resulting in significant effects for girls,

boys, or both genders. Regarding the definition of CSA, signif-

icant differences were found for girls only, with the studies

using the NIS-3 definition yielding the highest combined pre-

valence, followed by studies using a broader definition. Studies

using a stricter definition reported the lowest combined preva-

lence. For girls, the combined prevalence differed according to

the period of prevalence used in studies in order to assess the

occurrence of CSA. The combined prevalence was highest in

studies using a 0–14 year period, followed by 0–16 and 0–18

periods and by 0–17 and 0–15 periods. The lowest combined

prevalence was reported in studies using a 0–13 period. For

girls and boys, the reported prevalence was significantly influ-

enced by the inclusion or exclusion of an age difference

84 Child Maltreatment 16(2)

by guest on February 19, 2013cmx.sagepub.comDownloaded from

Table 2. Results of Moderator Analyses for Self-Report Studies: Number of Studies and Participants, and Combined Prevalence Including 95% Confidence Intervals (CI)

Female Samples Male Samples

Combined

Prevalence (%) 95% CI Contrast Q

Combined

Prevalence (%) 95% CI Contrast Q

Sample characteristics

Continent 19.28** 10.59*

Africa 8 13,318 20.2** 13.1–29.7 5 1,403 19.3* 8.9–37.0

Asia 11 5,466 11.3** 7.5–16.6 8 3,888 4.1** 2.0–8.3

Australia 12 16,372 21.5** 15.3–29.3 8 10,775 7.5** 3.8–14.2

Europe 39 35,468 13.5** 11.0–16.5 24 26,513 5.6** 3.8–8.4

South America 3 1,564 13.4** 6.2–26.5 2 415 13.8* 3.7–40.0

USA/Canada 120 143,883 20.1** 18.1–22.4 57 99,681 8.0** 6.2–10.2

Economic development 0.89 7.02**

High-resource 174 196,830 18.3** 16.7–20.0 91 138,398 6.8** 5.5–8.2

Low-resource 19 19,241 15.9** 11.9–20.9 13 4,277 14.0** 8.5–22.2

Ethnicity

5.15 3.90*

African American 12 3,332 26.3** 19.9–33.9 6 1,588 16.5** 7.6–32.1

Asian 1 278 25.0 9.0–53.0 1 192 11.0* 1.5–49.5

Caucasian 71 121,455 18.7** 16.6–21.0 34 88,096 7.2** 5.1–9.9

Hispanic 6 2,427 22.2** 14.7–32.2 3 1,864 7.7** 2.3–23.2

Age of respondent 2.61 2.92

Under 20 years 40 18,586 19.8** 16.4–23.8 19 9,020 6.6** 4.2–10.1

20–30 years 34 15,949 21.0** 17.1–25.5 25 15,344 10.4** 7.2–14.7

Over 30 years 40 47,346 16.8** 13.8–20.4 15 23,194 7.2** 4.4–11.4

Procedural moderators

Definition CSA 8.72** 2.57

Broader than NIS-3 59 44,365 19.1** 16.3–22.2 38 70,949 7.0** 5.0–9.7

Stricter than NIS-3 61 82,403 15.1** 12.9–17.7 38 51,320 6.9** 5.0–9.5

According to NIS-3 47 71,117 21.2** 17.8–25.0 17 11,906 10.7** 6.6–16.8

Period of prevalence

24.32** 4.26

0–12 3 2,248 6.6** 3.0–13.9 2 287 11.2* 3.0–34.0

0–13 8 2,562 6.6** 4.0–10.7 7 2,120 10.0** 5.0–19.1

0–14 7 2,623 28.8* 19.2–40.8 4 4,030 9.4** 3.7–21.7

0–15 14 20,390 16.4** 11.9–22.3 5 4,073 12.8** 5.8–26.0

0–16 43 36,657 19.0** 15.9–22.5 27 24,667 7.0** 4.9–9.9

0–17 14 11,045 16.2** 11.7–21.9 10 39,949 5.5** 3.1–9.8

0–18 94 135,778 18.7** 16.6–21.0 46 56,566 6.8** 5.1–9.0

Age difference 8.29** 11.8**

Difference specified 54 31,689 22.0** 18.8–25.6 25 18,935 12.9** 9.0–18.1

No difference specified 139 184,382 16.7** 15.0–18.4 79 123,740 6.2** 5.0–7.7

Type of instrument 10.52* 3.75

Interview face-to-face 41 21,889 17.4** 14.4–20.9 11 8,645 6.5** 3.5–11.6

Interview telephone 14 33,727 13.8** 9.9–18.8 12 21,149 5.4** 3.0–9.4

Questionnaire 127 139,125 19.7** 17.8–21.8 71 98,008 8.2** 6.5–10.3

Questionnaire computer 5 10,082 9.7** 5.4–16.9 6 12,252 4.5** 2.0–9.7

(continued)

by guest on February 19, 2013cmx.sagepub.comDownloaded from

Table 2 (continued)

Female Samples Male Samples

Combined

Prevalence (%) 95% CI Contrast Q

Combined

Prevalence (%) 95% CI Contrast Q

Instrument validated 0.07 1.82

No 112 142,622 17.6** 15.7–19.8 72 110,655 6.6** 5.2–8.4

Yes 69 68,899 18.1** 15.6–20.8 26 29,124 9.0** 6.1–13.0

Number of questions 30.11** 5.95

under 3 43 94,548 12.0** 10.0–14.3 28 73,051 4.8** 3.3–7.0

3–7 49 60,761 19.9** 17.0–23.1 28 33,808 10.4** 6.2–12.7

8 and over 47 26,807 22.5** 19.2–26.1 21 14,425 7.9** 5.2–11.8

Respondent 0.30 6.84*

Adult 156 124,449 18.4** 16.7–20.2 78 99,769 8.6** 7.0–10.7

Child 36 90,889 17.3** 14.2–21.0 24 42,017 4.7** 3.2–7.1

Response rate 6.40* 10.09**

Low 51 59,139 20.4** 17.2–24.1 25 70,781 6.1** 4.1–9.0

Moderate 48 65,601 14.9** 12.4–17.9 32 50,039 5.0** 3.5–7.1

High 45 72,091 18.8** 15.6–22.5 27 15,852 11.1** 7.7–15.8

Sampling procedure 1.93 12.31**

Convenience 106 60,308 19.1** 17.0–21.3 53 76,953 10.3* 7.9–13.3

Randomized 86 155,711 16.9** 14.8–19.2 51 65,722 5.2* 3.9–6.8

Sample size 25.50** 12.35**

Small 54 9,733 22.0** 18.8–25.4 29 4,760 12.0** 8.6–16.5

Medium 51 34,215 19.8** 17.5–22.3 39 13,804 7.2** 5.4–9.7

Large 55 172,123 13.0** 11.1–15.2 36 124,111 5.4** 4.0–7.2

Background moderators

Year of publication 4.10 1.48

Before 1990 24 10,969 18.3** 14.4–23.1 10 7,177 5.6** 2.9–10.7

1990–1999 80 52,202 19.8** 17.4–22.4 44 29,413 6.9** 5.4–9.7

After 1999 89 152,900 16.5** 14.6–18.7 50 106,083 8.3** 4.0–7.2

Publication outlet 5.24* —

Dissertation 5 1,822 31.8* 19.6–47.0 1 213 12.2 1.7–52.7

Journal 186 206,035 17.8** 16.3–19.4 102 135,434 7.4** 6.1–9.0

Note: CSA ¼childhood sexual abuse.

Subgroups with k< 4 or ‘‘other’’ categories are excluded from contrasts.

For the subset of studies originating from the United States and Canada.

Differences in totals of kare due to the exclusion from the pertinent analysis of studies with missing values.

All participants are included in a single category.

*p< .05.

**p< .01.

by guest on February 19, 2013cmx.sagepub.comDownloaded from

criterion between perpetrator and victim. The reported age

difference was usually 5 years (52 out of 54 studies on girls and

all of the studies on boys), and only twice an age difference of 3

years was used. The combined prevalence of studies including

such an age-difference criterion was higher than the combined

prevalence of studies without an age-difference criterion.

For girls but not for boys, the combined prevalence differed

between the types of instrument used to assess CSA. The lowest

combined prevalence was found in studies using a computerized

questionnaire, the highest in studies using paper-and-pencil

questionnaires. The combined prevalence of both types of inter-

views – face-to-face and by telephone – was in between the types

of questionnaires. For both genders, whether studies used a vali-

dated or a non-validated instrument was not a factor of influence

on combined prevalence. With respect to number of questions,a

larger number of questions about CSA concurred with a higher

combined prevalence for girls but not for boys. For boys but

not for girls, the respondent used in studies mattered with respect

to the combined prevalence, with adult men showing a higher

combined prevalence than boys.

Regarding response rate, the lowest combined prevalence

was found in the medium range for both genders, the highest

in the low range for girls and in the high range for boys. The

results of moderator analyses with sampling procedure were

significant for boys only. The combined prevalence reported

in studies using male convenience samples was approximately

twice the combined prevalence reported in studies using male

randomized samples. Furthermore, the larger the sample size,

the lower the combined prevalence for both girls and boys.

Publication moderators. No significant differences in

combined prevalence existed with regard to the year of

publication, independent of the gender of the sample. For girls

but not for boys, the result of the analysis with publication

outlet was significant. The combined prevalence of the studies

reported in dissertations was significantly higher than the

combined prevalence in studies reported in journals.

Discussion

Using meta-analytical methods, we combined prevalence

figures on CSA reported in 217 publications published

between 1982 and 2008. The global prevalence of CSA was

estimated to be 11.8%or 118 per 1000 children, based on

331 independent samples with a total of 9,911,748 partici-

pants. As hypothesized, a gap existed between the combined

prevalence from self-report studies and from informant stud-

ies. The difference was much larger than expected with self-

report studies yielding a combined rate that was 30 times

higher than the rate of informant studies (127 per 1000 chil-

dren vs. 4 per 1000 children). Sample characteristics and

methodological aspects of the informant studies might

account for part of the difference in reported prevalence. For

example, four out of eight informant studies were based on

reports of CSA during the last year whereas most of the

self-report studies used an up-to-18 year’s period of preva-

lence. Reporting CSA over a one year period limits the time

frame and reduces the number of persons that experienced

CSA compared to reporting CSA over the entire childhood

Africa Asia Australia Europe South

Americaa

USA/Canada

Estimated prevalence (%)

Girls Boys

Mean

male

Mean

female

Figure 1. Estimated combined prevalence for self-report studies of CSA, separated according to geographical area of origin of the sample and

to gender, including the overall combined prevalence for girls and boys. Stars represent a significant difference between girls and boys within

a geographical area of origin of the sample (*p< .05; **p< .01).

The significance of the analyses on the South American samples could not be tested, due to k<4.

Stoltenborgh et al. 87

by guest on February 19, 2013cmx.sagepub.comDownloaded from

period. Also, seven out of eight informant studies used

randomized samples whereas only about half of the self-report

studies did so. In the set of male self-report studies random

sampling resulted in a lower reported prevalence compared

to convenience samples, which points to the possibility that

randomized studies are associated with lower estimates. Last

but not least, all informant studies used reports registered by

professionals, thus excluding unreported cases of CSA that

might have been reported had self-report measures been used.

Gender

A substantial difference in the prevalence of self-reported CSA

was found between girls and boys. This was true globally and

Stricter NIS-3 broader

(a) Definition of CSA

Estimated prevalence (%)

12 13 14 15 16 17 18

(b) Period of prevalence

Estimated prevalence (%)

Specified Not specified

Estimated prevalence (%)

Interv f-

t-f

interv

tel

quest quest

comp

(d) Type of instrument

Estimated prevalence (%)

< 3 3 – 7 > 7

(e) Number of questions

Estimated prevalence (%)

Adult Child

(f) Respondent

Estimated prevalence (%)

Low Medium High

(g) Response rate

Estimated prevalence (%)

Randomized Convenience

(h) Sampling procedure

Estimated prevalence (%)

Small Medium Large

(i) Sample size

Estimated prevalence (%)

Girls Boys

** **

Figure 2. The influence on estimatedprevalence of self-report studiesof CSA of (a) the definition of CSA, (b) theperiod of prevalence,(c) whether an

age differe nce was specified in th e definition of CSA, (d ) the type of instrument , (e) the number of quest ions that were used to as sess CSA, (f) the

respondent, (g) the response rate, (h) the sampling procedure, and (i) the sample size. Dotted lines represent the overall mean estimated

reported prevalence for girls and boys. Stars represent a significant difference between categories within female or male studies (*p<.05;

**p<.01).

88 Child Maltreatment 16(2)

by guest on February 19, 2013cmx.sagepub.comDownloaded from

for most continents separately. Women reported CSA more

often than men, which is convergent with the meta-analysis

by Pereda et al. (2009b). The prevalence rates we found were

comparable to those reported in Pereda et al. (2009b): 18.0%

for girls and 7.6%for boys (Pereda et al., 2009b: 19.7%and

7.9%, respectively). Gender differences for reported preva-

lence of CSA may be due to either higher occurrence of CSA

among girls than among boys, or to boys’ more reluctant atti-

tude toward disclosing their CSA experiences, or both causes

might play a role (Dhaliwal, Gauzas, Antonowicz, & Ross,

1996; Finkelhor & Baron, 1986; O’Leary & Barber, 2008;

Romano & De Luca, 2001). Men might be reluctant to disclose

CSA for several reasons, among which feelings of weakness

and of failure because of society’s traditional view of men as

aggressors rather than as victims (Dhaliwal et al., 1996;

Romano & De Luca, 2001).

Moreover, boys might be afraid of being considered the

instigator of CSA rather than the victim (Dhaliwal et al.,

1996), or they may not view their sexual experiences with older

women as sexual abuse because of sex stereotypes (Coxell,

King, Mezey, & Gordon, 1999). As the majority of CSA perpe-

trators are male, male victims may also fear being regarded as

homosexual (Dhaliwal et al., 1996; Romano & De Luca, 2001).

Male victims who disclose their CSA experiences tend to do so

later than female victims (O’Leary & Barber, 2008). On aver-

age, it would take most male CSA victims more than 10 years

before they start to discuss their CSA experiences. For women,

the average period between the CSA experiences and disclo-

sure was found to be much shorter (O’Leary & Barber,

2008). This might contribute to higher rates for girls than for

boys, and explain our finding that for boys the prevalence was

higher in adult samples than in child samples, a finding that was

not replicated for girls.

Continent of Origin of the Sample

Continent of origin of the sample influenced the CSA

prevalence as well. This converges with the results of the

meta-analysis of Pereda et al. (2009b) but in that meta-

analysis separate prevalences for boys and girls per continent

were not reported. It should be noted that most prevalence stud-

ies have not been conducted with the explicit goal to compare

prevalence rates across a variety of cultures. In fact, the cultural

perspective on prevalence of child maltreatment across cultures

is still underdeveloped although recently some progress has

been made (Mbagaya, 2010). Geographical area and culture

may be overlapping but are not necessarily similar, and any

comparison between countries or continents might not be gen-

eralized to cultural differences. Nevertheless, Hofstede (2001)

proposed some major cultural dimensions that are globally

related to countries and geographic areas, and one of the

dimensions is individualism or the emphasis on the collective

(Hofstede, 2001), which might be relevant to child maltreat-

ment prevalence estimates.

For example, for girls and boys, we found the lowest com-

bined prevalence in Asia. The fairly low CSA rates for both

genders in Asia seem to be consistent with the idea that abuse

experiences are less often disclosed in a collectivist culture

than in individualistic cultures. The highest prevalence for girls

found in more individualistic countries like Australia and New

Zealand might partially stem from culturally based willingness

to disclose their sexual experiences and the ease with which

they talk about sexuality (Kenny & McEachern, 2000b;

Runyan, 1998). Values related to taboos on sexuality found

in many Hispanic cultures, or shame associated with disclosure

of CSA, are thought to prevent abused persons from talking

about their experiences. In the Hispanic cultures of South

America one might expect to find fairly low rates of reported

prevalence because of the secrecy around early sexual

experiences. The high combined rate of 22.2%among the

female Hispanic American samples is not consistent with this

expectation. Unfortunately, the number of studies originating

from South America was too small to be contrasted with those

of other continents. More studies on the prevalence of CSA

research in this geographical area are badly needed.

The alternative explanation would be that differences

between continents reflect real differences in the prevalence

of CSA. Mbagaya (2010), for example, argued that differences

in prevalence rates between countries may not (only) be due to

disclosure issues but to real socioeconomic and cultural differ-

ences. On the African continent, initiation rites representing the

‘‘transition into adulthood’’ in early and mid-adolescence may

encourage sexual behaviors with older persons (Mbagaya,

2010). Myths associated with HIV cure and avoidance strate-

gies may increase the prevalence of CSA in sub-Saharan Africa

(Lalor, 2008). In addition, young partners are considered less

likely to have HIV, and are thus preferred as sexual partners

(Madu & Peltzer, 2000). Furthermore, Madu and Peltzer

(2000) pointed out that the male dominant society in South

Africa may be responsible for high CSA rates because men

in such societies feel that they have authority over women and

children. The socialization of African children to unquestio-

ningly obey older people puts them at risk for sexual abuse

by people to whom they are expected to pay their respects

(Lalor, 2008; Mbagaya, 2010). Lastly, the rapid social changes

in Africa along with increases in urbanization and individual-

ism have led to greater isolation of families. In situations where

children are left with biologically unrelated caregivers when

parents go to work, the risk of sexually abusive experiences

increases (Mbagaya, 2010).

Procedural Moderators

Some procedural factors influenced self-reported prevalence of

CSA for boys and girls (e.g., sample size showing the same pat-

tern of influence for both genders), other factors influenced the

prevalence for only one of the genders (e.g., number of ques-

tions showed a significant effect for girls but not for boys).

Based on the effects on reported prevalence of procedural

moderators in our set of self-report studies, and the speculation

that the combined prevalence from informant studies might

underestimate while the combined prevalence from self-report

Stoltenborgh et al. 89

by guest on February 19, 2013cmx.sagepub.comDownloaded from

studies might overestimate the CSA prevalence rate, we suggest

some recommendations aiming at the reduction of possible

biases in estimations of CSA prevalence in self-report studies.

The use of sufficiently large population-based randomized

samples is indicated, and this not only because of the formal

aspect of generalizability to the general population of a coun-

try. In our meta-analysis, a lower combined prevalence for

self-report studies was found in male randomized samples

compared to male convenience samples, and self-report stud-

ies with larger sample sizes resultedinalowercombinedpre-

valence compared to studies with medium or small sample

sizes for both genders. The findings indicate that studies with

better methodological qualities yield lower estimated preva-

lence rates. Tentatively, this could be seen as evidence that

lowerprevalenceestimatescouldbemoreaccuratecompared

to higher prevalence estimates.

Limitations and Future Research

The heterogeneity in the subsets of studies, despite the mod-

erators that were taken into account, indicates that the sample

characteristics and methodological factors included in this

meta-analysis did not yet fully explain the vast variation in

self-reported rates of CSA. Unfortunately, the small number

of informant studies did not allow for examining the influence

of sample characteristics and methodological factors on the

estimated prevalence. Comparing moderators of prevalence

estimates for informant and self-report studies could add to

our understanding of the strengths and weaknesses of both

types of studies.

Studies using both informants and self-report data within a

single, nationally representative randomized sample could

contribute to clarifying the large difference in reported preva-

lence between these two study types. To ensure comparability

of the prevalence rates it would be imperative that identical,

clearly operationalized criteria for CSA are used for both the

informant and the self-report measurements. We would rec-

ommend using CSA criteria that correspond to the legal def-

inition of CSA in the specific country, so that the results of

studies will be useful for local policymakers. Alternatively,

the criteria for CSA could be derived from official interna-

tional organizations, for example, the definition provided by

the Consultation on Child Abuse Prevention of the World

Health Organization (1999). This would ensure the compar-

ability of prevalence among countries.

With regard to the measurement of CSA, the results of this

meta-analysis emphasize the recommendation of the use of

multiple behaviorally specific questions instead of a single-

item label question, in line with Koss’ (1993) recommendation

with regard to rape. By analogy with the measurement of infant

temperament, answers on behaviorally specific questions such

as ‘‘During the past week, when being undressed, how often did

your baby cry?’’ (Infant Behavior Questionnaire; Rothbart,

1981) provide more precise information than broad questions

such as ‘‘How much does your baby fuss/cry in general?’’

(Infant Characteristics Questionnaire; Bates, Bennett Freeland,

& Lounsbury, 1979). In this study, the use of one or two ques-

tions was associated with a stricter definition of CSA whereas a

broader definition of CSA was reflected in the use of more

questions. The use of behaviorally specific questions about

CSA would also eliminate a possible drawback of self-report

studies that leave the interpretation of the global term ‘‘sexual

abuse’’ to the participants’ subjective perceptions and defini-

tions. Developing an instrument including behaviorally specific

questions based on the rather broad, non behaviorally specific

definitions of CSA provided by international organizations

might prove to be quite challenging, especially if one would like

the instrument to be universally applicable. The development of

such an instrument might be preceded by a clearer specification

of the acts that constitute CSA according to international organi-

zations and across a wide variety of cultures. An empirical con-

ceptual analysis focusing at more concrete and precise

operationalizations of CSA might be especially useful. Such

an approach has, for example, been successful in the area of

attachment and sensitivity research (De Wolff & Van IJzendoorn,

1997; Posada et al., 2008).

In our opinion, the large costs to society of (the conse-

quences of) CSA would warrant the investment in a study using

both informant and self-report measures including multiple

behaviorally specific questions in the same large, randomized,

population-based sample, as such a study could provide the

most accurate estimate of CSA prevalence as a basis for pre-

ventive policy measures.

Conclusion

The current meta-analysis shows that CSA is a global problem

of considerable extent, even though methodological differences

between studies have an impact on the reported prevalence of

CSA. The prevalence rates contrast sharply with the United

Nations’ Convention on the Rights of the Child (1989) in which

the 194 ratifying countries (November 2009) explicitly state

that they shall take all appropriate legislative, administrative,

social, and educational measures, either nationally, bilaterally,

or multilaterally, in order to protect children from sexual abuse.

The results of our meta-analysis show a lower limit estimate of

self-reported CSA prevalence in girls of 164/1000 and an upper

limit estimate of 197/1000. For boys, the lower limit is 66/1000

and the upper limit is 88/1000. Even the lower bound estimates

are alarming in their demonstration that CSA is a global phe-

nomenon affecting the lives of millions of children.

90 Child Maltreatment 16(2)

by guest on February 19, 2013cmx.sagepub.comDownloaded from

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interests with respect

to the authorship and/or publication of this article.

Funding

MJBK and MHvIJ were supported by awards from the Netherlands

Organization for Scientific Research (MJBK: VIDI grant no. 452-

04-306; MHvIJ: SPINOZA prize).

References

Publications marked with an asterisk were included in the meta-analysis.

*Ackard, D. M., & Neumark-Sztainer, D. (2002). Date violence and

date rape among adolescents: Associations with disordered eating

behaviors and psychological health. Child Abuse & Neglect,26,

455-473. doi:10.1016/S0145-2134(02)00322-8.

*Afifi, Z. E. M., Basuily, W. W., El-Lawindi, M. I., & Ahmed, S. A.

(2003). Adolescent abuse in a community sample in Beni Suef,

Egypt: Prevalence and risk factors. Eastern Mediterranean Health

Journal,9, 1003-1018.

*Akyuz, G., Sar, V., Kugu, N., & Dogan, O. (2005). Reported child-

hood trauma, attempted suicide and self-mutilative behavior

among women in the general population. European Psychiatry,

20, 268-273. doi: 10.1016/j.eurpsy.2005.01.002.

*Alexander, P. C., & Lupfer, S. L. (1987). Family characteristics and

long-term consequences associated with sexual abuse. Archives of

Sexual Behavior,16, 235-245. doi: 10.1007/BF01541611..

*Amodeo, M., Griffin, M. L., Fassler, I. R., Clay, C. M., & Ellis, M. A.

(2006). Childhood sexual abuse among black women and white

women from two-parent families. Child Maltreatment,11,

237-246. doi:10.1177/1077559506289186.

*Anderson, J., Martin, J., Mullen, P., Romans, S., & Herbison, P.

(1993). Prevalence of childhood sexual abuse experiences in a

community sample of women. Journal of the American Academy

of Child and Adolescent Psychiatry,32, 911-919. doi: 10.1097/

00004583-199309000-00004.

*Ansara, D., Cohen, M. M., Gallop, R., Kung, R., & Schei, B. (2005).

Predictors of women’s physical health problems after childbirth.

Journal of Psychosomatic Obstetrics and Gynecology,26,

115-125. doi:10.1080/01443610400023064.

Appendix A

NIS-3 Definitions of Child Sexual Abuse

Specific Form of Maltreatment (NIS–3 code) Acts/Omissions Included

Penile intrusion (01.0) Sexually assaulting or exploiting a child or permitting sexual assault or exploitation of a

child where acts involving penile penetration of or by child have occurred. Such acts

include oral (fellatio), anal (sodomy), or genital intercourse, whether heterosexual

or homosexual. Category includes cases where sexual exploitation (involving

intrusion) by other persons was knowingly permitted by a person responsible for the

child (e.g., child’s prostitution, child’s involvement in pornography with intrusion,

child’s nonvoluntary involvement in intrusion sex). Category does not include sexual

abuse of an unknown nature, situations encompassed by categories in 02 or 03, nor

inadequate supervision of child’s voluntary sexual activities. The mere presence of

venereal disease does not constitute adequate evidence to support that this form of

maltreatment occurred.

Intrusion by finger or any object (01.1) Sexually assaulting or exploiting a child or permitting sexual assault or exploitation of a

child where acts involving penetration with fingers or any object, of or by child, have

occurred.

Molestation with genital contact (02.0) Sexually assaulting or exploiting a child or permitting sexual assault or exploitation of

a child where acts involving genital contact of or by child—but not involving

(specific indications of) actual intrusion—have occurred. Such acts would include

penile or vaginal fondling or stimulation of or by child, whether heterosexual or

homosexual.

Other or unknown sexual abuse (03.0) Committing or permitting sexual assault, exploitation, maltreatment, or abuse other

than categories 01 and 02, above. This could include: sexual assault or exploitation

where acts did not involve actual intrusion or genital contact (e.g., exposure, inap-

propriate kissing, hugging, fondling of breasts, buttocks, or other nongenital areas,

etc.); and sexual assault or molestation where acts were of unknown or unspecified

nature (i.e., no specific indication that intrusion or genital contact had occurred).

Category includes all allegations involving child’s voluntary sexual activities, such as

allegations concerning inadequate or inappropriate supervision of child’s voluntary

sexual activities. Category does not include attempted, threatened, or potential

sexual assault or exploitation if no actual sexual contact was indicated to have

occurred. When no physical contact appears to have occurred, allegation should be

coded elsewhere (see categories 06

and 07

Extracted from Sedlak (2001).

Emotional abuse, category verbal or emotional assault.

Emotional abuse, category other or unknown abuse.

Stoltenborgh et al. 91

by guest on February 19, 2013cmx.sagepub.comDownloaded from

*Arreola, S. G., Neilands, T. B., Pollack, L. M., Paul, J. P., & Catania, J.

A. (2005). Higher prevalence of childhood sexual abuse among

Latino men who have sex with men than non-Latino men who have

sex with men: Data from the Urban Men’s Health Study. Child

Abuse & Neglect,29, 285-290. doi:10.1016/j.chiabu.2004.09.003.

*Arroyo, J. A., Simpson, T. L., & Aragon, A. S. (1997). Childhood

sexual abuse among Hispanic and non-Hispanic white college

women. Hispanic Journal of Behavioral Sciences,19, 57-68.

doi:10.1177/07399863970191004.

*Aspelmeier, J. E., Elliot, A. N., & Smith, C. H. (2007). Childhood

sexual abuse, attachment, and trauma symptoms in college

females: The moderating role of attachment. Child Abuse and

Neglect,31, 549-566. doi:10.1016/j.chiabu.2006.12.002.

*Baccini, F., Pallota, N., Calabrese, E., Pezzotti, P., & Corazziari, E.

(2003). Prevalence of sexual and physical abuse and its relation-

ship with symptom manifestations in patients with chronic organic

and functional gastrointestinal disorders. Digestive and Liver

Disease,35, 256-261. doi:10.1016/S1590-8658(03)00075-6.

*Back, S. E., Jackson, J. L., Fitzgerald, M., Shaffer, A., Salstrom, S.,

& Osman, M. M. (2003). Child sexual and physical abuse among

college students in Singapore and the United States. Child Abuse

and Neglect,27, 1259-1275. doi:10.1016/j.chiabu.2003.06.001.

*Bagley, C., & Ramsay, R. (1986). Sexual abuse in childhood: Psy-

chosocial outcomes and implications for social work practice.

Journal of Social Work & Human Sexuality,4, 33-47.

*Bagley, C., Wood, M., & Young, L. (1994). Victim to abuser—

Mental-health and behavioral sequels of child sexual abuse in a

community survey of young-adult males. Child Abuse & Neglect,

18, 683-697. doi:10.1016/0145-2134(94)90018-3.

*Baker, A. W., & Duncan, S. P. (1985). Child sexual abuse: A study of

prevalence in Great Britain. Child Abuse and Neglect,9, 457-467.

doi:10.1016/0145-2134(85)90054-7.

Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., & Juffer, F.

(2003). Less is more: Meta-analyses of sensitivity and attachment

interventions in early childhood. Psychological Bulletin,129,

195-215. doi:10.1037/0033-2909.129.2.195.

*Banyard, V. L., Arnold, S., & Smith, J. (2000). Childhood sexual

abuse and dating experiences of undergraduate women. Child

Maltreatment,5, 39-48. doi:10.1177/1077559500005001005.

Barel, E., van IJzendoorn, M. H., Sagi-Schwartz, A., & Bakermans-

Kranenburg, M. J. (2010). Surviving the holocaust: a meta-

analysis of the long-term sequelae of a genocide. Psychological

Bulletin,136, 677-698. doi:10.1037/a0020339.

*Basile, K. C., Chen, J., Black, M. C., & Saltzman, L. E. (2007). Pre-

valence and characteristics of sexual violence victimization among

U.S. adults, 2001-2003. Violence and Victims,22, 437-448.

doi:10.1891/088667007781553955.

Bates, J. E., Bennett Freeland, C. A. B., & Lounsbury, M. L. (1979).

Measurement of infant difficultness. Child Development,50,

794-803. doi:10.1111/j.1467-8624.1979.tb02428.x.

Beitchman, J. H., Zucker, K. J., Hood, J. E., Dacosta, G. A., &

Akman, D. (1991). A review of the short-term effects of child sex-

ual abuse. Child Abuse & Neglect,15, 537-556. doi:10.1016/0145-

2134(91)90038-F.

Beitchman, J. H., Zucker, K. J., Hood, J. E., Dacosta, G. A.,

Akman, D., & Cassavia, E. (1992). A review of the long-term

effects of child sexual abuse. Child Abuse & Neglect,16,

101-118. doi:10.1016/0145-2134(92)90011-F.

*Ben-Arieh, A., & Haj-Yahia, M. M. (2006). The ‘‘geography’’ of

child maltreatment in Israel: Findings from a national data set of

cases reported to the social services. Child Abuse and Neglect,

30, 991-1003. doi:10.1016/j.chiabu.2006.02.014.

*Bendixen, M., Muus, K. M., & Schei, B. (1994). The impact of child

sexual abuse—A study of a random sample of Norwegian students.

Child Abuse & Neglect,18, 837-847. doi:10.1016/0145-

2134(94)90063-9.

*Benedict, M. I., Paine, L. L., Paine, L. A., Brandt, D., & Stallings, R.

(1999). The association of childhood sexual abuse with depressive

symptoms during pregnancy, and selected pregnancy outcomes.

Child Abuse & Neglect,23, 659-670. doi:10.1016/S0145-

2134(99)00040-X.

*Bensley, L. S., Van Eenwyk, J., Spieker, S. J., & Schoder, J. (1999).

Self-reported abuse history and adolescent problem behaviors. I.

Antisocial and suicidal behaviors. Journal of Adolescent Health,

24, 163-172. doi: 10.1016/S1054-139X(98)00111-6.

*Bensley, L., Van Eenwyk, J., & Simmons, K. W. (2003). Childhood

family violence history and women’s risk for intimate partner vio-

lence and poor health. American Journal of Preventive Medicine,

25, 38-44. doi:10.1016/S0749-3797(03)00094-1.

*Berenson, A. B., Miguel, V. V. S., & Wilkinson, G. S. (1992). Pre-

valence of physical and sexual assault in pregnant adolescents.

Journal of Adolescent Health,13, 466-469. doi:10.1016/1054-

139X(92)90008-Y.

*Bergdahl, J. B. (1983). Differences in demographic features and

present anxiety level among college women who report type,

extent and rated severity of childhood and adolescent sexual con-

tacts with adults. Dissertation-Abstracts-International,44(01),

296-B.

*Berliner, L., Fine, D., & Moore, D. (2001). Sexual assault experi-

ences and perceptions of community response to sexual assualt:

A survey of Washington state women. Olympia, WA: Office of

Crime Victims Advocacy.

*Bernat, J. A., Ronfeldt, H. M., Calhoun, K. S., & Arias, I. (1998).

Prevalence of traumatic events and peritraumatic predictors of

posttraumatic stress symptoms in a nonclinical sample of college

students. Journal of Traumatic Stress,11, 645-664. doi:10.1023/

A:1024485130934.

Borenstein, M., Hedges, L., & Rothstein, D. (2007). Meta-analysis:

Fixed effect vs. random effects. Retrieved from http://www.meta-

analysis.com/downloads/Meta-analysis_fixed_effect_vs_random_

effects_sv.pdf

Borenstein, M., Rothstein, D., & Cohen, J. (2005). Comprehensive

meta-analysis: A computer program for research synthesis. [Com-

puter software]. Englewood, NJ: Biostat.

*Bouvier, P., Halpe´rin, D., Rey, H., Jaffe´, P. D, Laederach, J.,

Mounoud, R. L., & Pawlak, C. (1999). Typology and correlates

of sexual abuse in children and youth: Multivariate analyses in a

prevalence study in Geneva. Child Abuse and Neglect,23,

779-790. doi:10.1016/S0145-2134(99)00050-2.

*Boyer, D., & Fine, D. (1992). Sexual abuse as a factor in adolescent

pregnancy and child maltreatment. Family Planning Perspectives,

24, 4-19. doi:10.2307/2135718.

92 Child Maltreatment 16(2)

by guest on February 19, 2013cmx.sagepub.comDownloaded from

*Brayden, R. M., Deitrich-MacLean, G., Dietrich, M. S., Sherrod, K. B.,

& Altemeier, W. A. (1995). Evidence for specific effects

of childhood sexual abuse on mental well-being and physical

self-esteem. Child Abuse & Neglect,19, 1255-1262. doi:10.1016/

0145-2134(95)00078-M.

*Brener, N. D., McMahon, P. M., Warren, C. W., & Douglas, K. A.

(1999). Forced sexual intercourse and associated health-risk beha-

viors among female college students in the United States. Journal

of Consulting and Clinical Psychology,67, 252-259. doi:10.1037/

0022-006X.67.2.252.

*Briere, J., & Elliot, D. M. (2003). Prevalence and psychological

sequelae of self-reported childhood physical and sexual abuse in

a general population sample of men and women. Child Abuse and

Neglect,27, 1205-1222. doi:10.1016/j.chiabu.2003.09.008.

*Briere, J., & Runtz, M. (1988). Symptomatology associated with child-

hood sexual victimization in a nonclinical adult sample. Child Abuse

and Neglect,12, 51-59. doi:10.1016/0145-2134(88)90007-5.

*Brooker, S., Cawson, P., Kelly, G., & Wattam, C. (2001). The preva-

lence of child abuse and neglect: A survey of young people. Inter-

national Journal of Market Research,43, 249-289.

*Brown, J., Berenson, K., & Cohen, P. (2005). Documented and self-

reported child abuse and adult pain in a community sample. Clin-

ical Journal of Pain,21, 374-377. doi:10.1097/01.ajp.0000149797.

16370.dc.

*Brown, J., Cohen, P., Johnson, J. G., & Salzinger, S. (1998). A long-

itudinal analysis of risk factors for child maltreatment: findings of

a 17-year prospective study of officially recorded and self-reported

child abuse and neglect. Child Abuse and Neglect,22, 1065-1078.

doi:10.1016/S0145-2134(98)00087-8.

Browne, A., & Finkelhor, D. (1986). Initial and long-term effects: a

review of the research. In D. Finkelhor (Ed.), A sourcebook on

child sexual abuse, (pp. 119-142). Beverly Hills, CA: Sage.

*Bryant, S. L., & Range, L. M. (1997). Type and severity of child

abuse and college students’ lifetime suicidality. Child Abuse and

Neglect,21, 1169-1176. doi:10.1016/S0145-2134(97)00092-6.

*Calam, R. M., & Slade, P. D. (1989). Sexual experience and eating

problems in female undergraduates. International Journal of Eating

Disorders,8, 391-397. doi:10.1002/1098-108X(198907)8:

4<391::AID-EAT2260080402>3.0.CO;2-P.

*Caspi, A., McClay, J., Moffitt, T. E., Mill, J., Martin, J., &

Craig, I. W, ... Poulton, R. (2002). Role of genotype in the cycle

of violence in maltreated children. Science,297, 851-854.

doi:10.1126/science.1072290.

*Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R.,

Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experi-

ences and the risk of depressive disorders in adulthood. Journal of

Affective Disorders,82, 217-225. doi:10.1016/j.jad.2003.12.013.

*Chartier, M. J., Walker, J. R., & Naimark, B. (2007). Childhood

abuse, adult health, and health care utilization: Results from a rep-

resentative community sample. American Journal of Epidemiol-

ogy,165, 1031-1038. doi:10.1093/aje/kwk113.

*Chen, J. Q., Dunne, M. P., & Han, P. (2004). Child sexual abuse in

China: A study of adolescents in four provinces. Child Abuse and

Neglect,28, 1171-1186. doi:10.1016/j.chiabu.2004.07.003.

*Chen, J. Q., Dunne, M. P., & Han, P. (2006). Child sexual abuse in

Henan province, China: Associations with sadness, suicidality, and

risk behaviors among adolescent girls. Journal of Adolescent

Health,38, 544-549. doi:10.1016/j.jadohealth.2005.04.001.

*Chibnall, J. T., Wolf, A., & Duckro, P. N. (1998). A national survey

of the sexual trauma experiences of Catholic nuns. Review of

Religious Research,40, 142-167. doi:10.2307/3512299.

*Choquet, M., DarvesBornoz, J. M., Ledoux, S., Manfredi, R., &

Hassler, C. (1997). Self-reported health and behavioral problems

among adolescent victims of rape in France: Results of a cross-

sectional survey. Child Abuse & Neglect,21, 823-832. doi:10.1016/

S0145-2134(97)00044-6.

*Clemmons, J. C., DiLillo, D., Martinez, I. G., DeGue, S., &

Jeffcott, M. (2003). Co-occurring forms of child maltreatment and

adult adjustment reported by Latina college students. Child Abuse

and Neglect,27, 751-767. doi:10.1016/S0145-2134(03)00112-1.

*Cohen, R. A., Paul, R. H., Stroud, L., Gunstad, J., Hitsman, B. L.,

Mccaffery, J., & ... Gordon, E. (2006). Early life stress and adult

emotional experience: An international perspective. International

Journal of Psychiatry in Medicine,36, 35-52. doi:10.2190/5R62-

9PQY-0NEL-TLPA.

*Coid, J., Petruckevitch, A., Chung, W. S., Richardson, J., Moorey, S.,

& Feder, G. (2003). Abusive experiences and psychiatric morbid-

ity in women primary care attenders. British Journal of Psychiatry,

183, 332-339. doi:10.1192/bjp.183.4.332.

*Collings, S. J. (1995). The long-term effects of contact and noncon-

tact forms of child sexual abuse in a sample of university men.

Child Abuse and Neglect,19, 1-6. doi:10.1016/0145-2134(94)

00098-F.

*Collings, S. J. (1997). Child sexual abuse in a sample of South Afri-

can women students: Prevalence, characteristics, and long-term

effects. South African Journal of Psychology—Suid-Afrikaanse

Tydskrif Vir Sielkunde,27, 37-42.

*Collishaw, S., Pickles, A., Messer, J., Rutter, M., Shearer, C., &

Maughan, B. (2007). Resilience to adult psychopathology follow-

ing childhood maltreatment: Evidence from a community sample.

Child Abuse and Neglect,31, 211-229. doi:10.1016/j.chiabu.

2007.02.004.

*Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007).

Traumatic events and posttraumatic stress in childhood. Archives

of General Psychiatry,64, 577-584. doi:10.1001/archpsyc.64.5.577.

*Coxell, A., King, M., Mezey, G., & Gordon, D. (1999). Lifetime pre-

valence, characteristics, and associated problems of non-consensual

sex in men: Cross sectional survey. British Medical Journal,318,

846-850.

Cyr, C., Euser, E. M., Bakermans-Kranenburg, M. J., & Van

IJzendoorn, M. H. (2010). Attachment security and disorganization

in maltreating and high-risk families: A series of meta-analyses.

Development and Psychopathology,22, 87-108. doi:10.1017/

S0954579409990289.

*Dalenberg, C. J., & Palesh, O. G. (2004). Relationships between

child abuse history, trauma, and dissociation in Russian college

students. Child Abuse and Neglect,28, 461-474. doi:10.1016/

j.chiabu.2003.11.020.

*De Paul, J., Milner, J. S., & Mugica, P. (1995). Childhood maltreat-

ment, childhood social support, and child-abuse potential in a Bas-

que sample. Child Abuse & Neglect,19, 907-920. doi:10.1016/

0145-2134(95)00053-B.

Stoltenborgh et al. 93

by guest on February 19, 2013cmx.sagepub.comDownloaded from

*De Von Figueroa-Moseley, C. D., Landrine, H., & Klonoff, E. A.

(2004). Sexual abuse and smoking among college student women.

Addictive Behaviors,29, 245-251. doi:10.1016/j.addbeh.2003.07.004.

De Sanjose, S., Diaz, M., Castellsaue, X., Clifford, G., Bruni, L.,

Munoz, N., & Bosch, F. X. (2007). Worldwide prevalence and gen-

otype distribution of cervical human papillomavirus DNA in

women with normal cytology: A meta-analysis. The Lancet Infec-

tious Diseases,7, 453-459. doi:10.1016/S1473-3099(07)70158-5.

De Wolff, M. S., & van IJzendoorn, M. H. (1997). Sensitivity and

attachment: A meta-analysis on parental antecedents of infant

attachment. Child Development,68, 571-591. doi:10.2307/1132107.

*DeLahunta, E. A., & Tulsky, A. A. (1996). Personal exposure of

faculty and medical students to family violence. Journal of the

American Medical Association,275, 1903-1906. doi:10.1001/jama.

275.24.1903.

Dhaliwal, G. K., Gauzas, L., Antonowicz, D. H., & Ross, R. R. (1996).

Adult male survivors of childhood sexual abuse: Prevalence, sex-

ual abuse characteristics, and long-term effects. Clinical Psychol-

ogy Review,16, 619-639. doi:10.1016/S0272-7358(96)00018-9.

*Diaz, A., Simantov, E., & Rickert, V. I. (2002). Effect of abuse on

health—Results of a national survey. Archives of Pediatrics &

Adolescent Medicine,156, 811-817. doi:10.1016/S1083-3188(00)

00017-6.

*Diaz-Olavarrieta, C., Paz, F., de la Cadena, C. G., & Campbell, J.

(2001). Prevalence of intimate partner abuse among nurses and

nurses’ aides in Mexico. Archives of Medical Research,32,

79-87. doi:10.1016/S0188-4409(00)00262-9.

*DiLillo, D., DeGue, S., Kras, A., Di Loreto-Colgan, A. R., &

Nash, C. (2006a). Participant responses to retrospective surveys

of child maltreatment: Does mode of assessment matter? Violence

and Victims,21, 410-424. doi:10.1891/vivi.21.4.410.

*DiLillo, D., Fortier, M. A., Hayes, S. A., Trask, E., Perry, A. R.,

Messman-Moore, T., & ... Nash, C. (2006b). Retrospective

assessment of childhood sexual and physical abuse: A comparison

of scaled and behaviorally specific approaches. Assessment,13,

297-312. doi:10.1177/1073191106288391.

*Ditomasso, M. J., & Routh, D. K. (1993). Recall of abuse in child-

hood and three measures of dissociation. Child Abuse & Neglect,

17, 477-485. doi:10.1016/0145-2134(93)90022-W.

*Divasto, P. V., Kaufman, A., Rosner, L., Jackson, R., Christy, J.,

Pearson, S., & Burgett, T. (1984). The Prevalence of sexually

stressful events among females in the general-population. Archives

of Sexual Behavior,13, 59-67. doi:10.1007/BF01542978.

*Duncan, R. D. (2000). Childhood maltreatment and college drop-out

rates—Implications for child abuse researchers. JournalofInterper-

sonal Violence,15, 987-995. doi:10.1177/088626000015009005.

*Dunkle, K. L., Jewkes, R. K., Brown, H. C., Yoshihama, M., Gray, G.

E., McIntyre, J. A., & Harlow, S. D. (2004). Prevalence and pat-

terns of gender-based violence and revictimization among women

attending antenatal clinics in Soweto, South Africa. American

Journal of Epidemiology,160, 230-239. doi:10.1093/aje/kwh194.

*Dunne, M. P., Purdie, D. M., Cook, M. D., Boyle, F. M., &

Najman, J. M. (2003). Is child sexual abuse declining? Evidence

from a population-based survey of men and women in Australia.

Child Abuse & Neglect,27, 141-152. doi:10.1016/S0145-2134

(02)00539-2.

*Duran, B., Malcoe, L. H., Sanders, M., Waitzkin, H., Skipper, B., &

Yager, J. (2004). Child maltreatment prevalence and mental disor-

ders outcomes among American Indian women in primary care.

Child Abuse & Neglect,28, 131-145. doi:10.1016/j.chiabu.2003.

06.005.

Duval, S., & Tweedie, R. (2000a). A nonparametric ‘‘trim and fill’’

method of accounting for publication bias in meta-analysis. Journal

of the American Statistical Association,95, 89-98. doi:10.2307/

2669529.

Duval, S., & Tweedie, R. (2000b). Trim and fill: A simple funnel-

plot-based method of testing and adjusting for publication bias in

meta-analysis. Biometrics,56, 455-463. doi:10.1111/j.0006-341X.

2000.00455.x.

*Eaton, D. K. (2006). Youth risk behavior surveillance—United

States, 2005. Journal of school health,76, 353-372. doi:10.1111/

j.1746-1561.2006.00127.x.

*Edgardh, K., & Ormstad, K. (2000). Prevalence and characteristics of

sexual abuse in a national sample of Swedish seventeen-year-old

boys and girls. Acta Paediatrica,89, 310-319. doi:10.1111/

j.1651-2227.2000.tb01333.x.

*Elbedour, S., Abu-Bader, S., Onwuegbuzie, A. J., Abu-Rabia, A., &

El-Aassam, S. (2006). Erratum to ‘‘The scope of sexual, physical,

and psychological abuse in a Bedouin-Arab community of female

adolescents: The interplay of racism, urbanization, polygamy, fam-

ily honor, and the social marginalization of women.’’. Child Abuse

and Neglect,30, 577. doi:10.1016/j.chiabu.2006.06.003.

*Elliot, D. M., & Briere, J. (1992). Sexual abuse trauma among pro-

fessional women: Validating the trauma symptom checklist-40

(TSC-40). Child Abuse and Neglect,16, 391-398. doi:10.1016/

0145-2134(92)90048-V.

*Elliott, D. M. (1997). Traumatic events: Prevalence and delayed

recall in the general population. Journal of Consulting and Clinical

Psychology,65, 811-820.

*Epstein, M. A., & Bottoms, B. L. (1998). Memories of childhood

sexual abuse: A survey of young adults. Child Abuse and Neglect,

22, 1217-1238. doi:10.1037//0022-006X.65.5.811.

*Ernst, C., Angst, J., & Foldenyi, M. (1993). The Zurich Study XVII.

Sexual abuse in childhood—Frequency and relevance for adult

morbidity data of a longitudinal epidemiologic-study. European

Archives of Psychiatry and Clinical Neuroscience,242, 293-300.

*Eskin, M., Kaynak-Demir, H., & Demir, S. (2005). Same-sex sexual

orientation, childhood sexual abuse, and suicidal behavior in uni-

versity students in Turkey. Archives of Sexual Behavior,34,

185-195. doi:10.1007/s10508-005-1796-8.

*Essock-Vitale, S. M., & Mcguire, M. T. (1985). Women’s lives

viewed from an evolutionary perspective .1. Sexual histories,

reproductive success, and demographic characteristics of a random

sample of American women. Ethology and Sociobiology,6,

137-154. doi:10.1016/0162-3095(85)90027-5.

Euser, E. M., Van IJzendoorn, M. H., Prinzie, P., & Bakermans-

Kranenburg, M. J. (2010). Prevalence of child maltreatment in the

Netherlands. Child Maltreatment,15, 5-17. doi:10.1177/1077

559509345904.

*Everill, J., & Waller, G. (1995). Disclosure of sexual abuse and

psychological adjustment in female undergraduates. Child Abuse

& Neglect,19, 93-100. doi:10.1016/0145-2134(94)00102-Z.

94 Child Maltreatment 16(2)

by guest on February 19, 2013cmx.sagepub.comDownloaded from

Fallon, B., Trocme, N., Fluke, J., MacLaurin, B., Tonmyr, L., &

Yuan, Y. Y. (2010). Methodological challenges in measuring child

maltreatment. Child Abuse & Neglect,34, 70-79. doi:10.1016/

j.chiabu.2009.08.008.

*Fanslow, J. L., Robinson, E. M., Crengle, S., & Perese, L. (2007).

Prevalence of child sexual abuse reported by a cross-sectional sam-

ple of New Zealand women. Child Abuse & Neglect,31, 935-945.

doi:10.1016/j.chiabu.2007.02.009.

Fergusson, D. M., & Mullen, P. E. (1999). Childhood sexual abuse: An

evidence-based perspective. Thousand Oaks, CA: Sage.

*Fergusson, D. M., & Horwood, L. J. (1998). Exposure to interparen-

tal violence in childhood and psychosocial adjustment in young

adulthood. Child Abuse and Neglect,22, 339-357. doi:10.1016/

S0145-2134(98)00004-0.

*Figueiredo, B., Bifulco, A., Paiva, C., Maia, A., Fernandes, E., &

Matos, R. (2004). History of childhood abuse in Portuguese par-

ents. Child Abuse and Neglect,28, 669-682. doi:10.1016/j.chiabu.

2003.11.021.

*Fillingim, R. B., & Edwards, R. R. (2005). Is self-reported childhood

abuse history associated with pain perception among healthy

young women and men? Clinical Journal of Pain,21, 387-397.

doi:10.1097/01.ajp.0000149801.46864.39.

Finkelhor, D., & Baron, L. (1986). High-risk children. In D. Finkelhor

(Ed.), A sourcebook on child sexual abuse, (pp. 60-88). Beverly Hills,

CA: Sage.

Finkelhor, D. (1994). The international epidemiology of child

sexual abuse. Child Abuse & Neglect,18, 409-417. doi:10.1016/

0145-2134(94)90026-4.

*Finkelhor, D., & Dziuba-Leatherman, J. (1994). Children as victims

of violence: A national survey. Pediatrics,94, 413-420.

*Finkelhor, D., Moore, D., Hamby, S. L., & Straus, M. A. (1997).

Sexually abused children in a national survey of parents: Methodo-

logical issues. Child Abuse and Neglect,21, 1-9. doi:10.1016/

S0145-2134(96)00127-5.

*Finkelhor, D., Ormrod, R., Turner, H., & Hamby, S. L. (2005). The vic-

timization of children and youth: A comprehensive, national survey.

Child Maltreatment,10, 5-25. doi:10.1177/1077559504271287.

*Flanagan, A. S., & Furman, W. C. (2000). Sexual victimization and

perceptions of close relationships in adolescence. Child Maltreat-

ment,5, 350-359. doi:10.1177/1077559500005004006.

*Fleming, J. M. (1997). Prevalence of childhood sexual abuse in a

community sample of Australian women. Medical Journal of

Australia,166, 65-68.

*Fox, K. M., & Gilbert, B. O. (1994). The interpersonal and psycho-

logical functioning of women who experienced childhood physical

abuse, incest, and parental alcoholism. Child Abuse & Neglect,18,

849-858. doi:10.1016/0145-2134(94)90064-7.

*Fricker, A. E., Smith, D. W., Davis, J. L., & Hanson, R. F. (2003).

Effects of context and question type on endorsement of childhood

sexual abuse. Journal of Traumatic Stress,16, 265-268. doi:10.

1023/A:1023748124626.

*Fritz, G. S., Stoll, K., & Wagner, N. N. (1981). A comparison of

males and females who were sexually molested as children. Jour-

nal of Sex & Marital Therapy,7, 54-59.

*Fromuth, M. E. (1983). The long term psychological impact of child-

hood sexual abuse. Dissertation-Abstracts-International,44, 2242.

*Fromuth, M. E. (1986). The Relationship of childhood sexual abuse

with later psychological and sexual adjustment in a sample of

college-women. Child Abuse & Neglect,10, 5-15. doi:10.1016/

0145-2134(86)90026-8.

*Gagne´, M. H, Lavoie, F., & He´bert, M. (2005). Victimization during

childhood and revictimization in dating relationships in adolescent

girls. Child Abuse and Neglect,29, 1155-1172. doi:10.1016/

j.chiabu.2004.11.009.

*Gibson, R. L., & Hartshorne, T. S. (1996). Childhood sexual abuse

and adult loneliness and network orientation. Child Abuse &

Neglect,20, 1087-1093. doi:10.1016/0145-2134(96)00097-X.

Gilbody, S. M., Song, F. J., Eastwood, A. J., & Sutton, A. (2000). The

causes, consequences and detection of publication bias in psychia-

try. Acta Psychiatrica Scandinavica,102, 241-249. doi:10.1034/

j.1600-0447.2000.102004241.x.

Goldman, J. D. G., & Padayachi, U. K. (2000). Some methodological

problems in estimating incidence and prevalence in child sexual

abuse research. The Journal of Sex Research,37, 305-314.

doi:10.1080/00224490009552052.

*Goldman, J. D. G., & Padayachi, U. K. (1997). The prevalence and

nature of child sexual abuse in Queensland, Australia. Child Abuse

and Neglect,21, 489-498. doi:10.1016/S0145-2134(97)00008-2.

*Goldman, R. J., & Goldman, J. D. G. (1988). The prevalence and

nature of child sexual abuse in Australia. Australian Journal of

Sex, Marriage & Family,9, 94-106.

*Grayson, C. E., & Nolen-Hoeksema, S. (2005). Motives to drink as

mediators between childhood sexual assault and alcohol problems

in adult women. Journal of Traumatic Stress,18, 137-145.

doi:10.1002/jts.20021.

*Grimstad, H., Schei, B., Backe, B., & Jacobsen, G. (1997). Physical

abuse and low birthweight: A case-control study. British Journal of

Obstetrics and Gynaecology,104, 1281-1287. doi:10.1111/j.1471-

0528.1997.tb10975.x.

*Hall, E., & Flannery, P. J. (1984). Prevalence and correlates of sexual

assault experiences in adolescents. Victimology,9, 398-406.

*Halperin, D. S., Bouvier, P., Jaffe, P. D., Mounoud, R. L., Pawlak, C.

H., Laederach, J., & ... Astie´, F (1996). Prevalence of child sexual

abuse among adolescents in Geneva: Results of a cross sectional

survey. British Medical Journal,312, 1326-1329.

*Hatfield, S. A. (1987). Symptomatology associated with male

adult survivors of childhood sexual abuse. Dissertation-Abstracts-

International,48, 2771-2772.

*Haugaard, J. J., & Emery, R. E. (1989). Methodological issues in

child sexual abuse research. Child Abuse & Neglect,13, 89-100.

doi:10.1016/0145-2134(89)90032-X.

Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis.

Orlando, FL: Academic Press.

*Helweg-Larsen, K., & Larsen, H. B. (2006). The prevalence of

unwanted and unlawful sexual experiences reported by Danish

adolescents: Results from a national youth survey in 2002. Acta

Paediatrica,95, 1270-1276. doi:10.1080/08035250600589033.

*Hetzel, M. D., & McCanne, T. R. (2005). The roles of peritraumatic

dissociation, child physical abuse, and child sexual abuse in the

development of posttraumatic stress disorder and adult victimiza-

tion. Child Abuse & Neglect,29, 915-930. doi:10.1016/j.chiabu.

2004.11.008.

Stoltenborgh et al. 95

by guest on February 19, 2013cmx.sagepub.comDownloaded from

*Hibbard, R. A., Ingersoll, G. M., & Orr, D. P. (1990). Behavioral risk,

emotional risk, and child-abuse among adolescents in a nonclinical

setting. Pediatrics,86, 896-901.

*Hill, J., Davis, R., Byatt, M., Burnside, E., Rollinson, L., & Fear, S.

(2000). Childhood sexual abuse and affective symptoms in

women: A general population study. Psychological Medicine,30,

1283-1291. doi:10.1017/S0033291799003037.

*Himelein,M.J.,Vogel,R.E.,&Wachowiak,D.G.(1994).Non-

consensual sexual experiences in precollege women—Prevalence

and risk-factors. Journal of Counseling and Development,72,

411-415.

Hofstede, G. (2001). Culture’s consequences. Comparing values, beha-

viors, institutions, and organizations across nations. Thousand

Oaks, CA: Sage.

*Hooper, P. D. (1990). Psychological sequelae of sexual abuse in

childhood. British Journal of General Practice,40, 29-31.

*Howard, D. E., & Wang, M. Q. (2005). Psychosocial correlates of US

adolescents who report a history of forced sexual intercourse. Jour-

nal of Adolescent Health,36, 372-379. doi:10.1016/j.jadohealth.

2004.07.007.

*Hussey,J.M.,Chang,J.J.,&Kotch,J.B.(2006).Childmaltreat-

ment in the United States: Prevalence, risk factors, and adolescent

health consequences. Pediatrics,118, 933-942. doi:10.1542/peds.

2005-2452.

International Monetary Fund. (2010). World economic outlook: Spil-

lovers and cycles in the global economy. Washington, DC: Author.

*Jewkes, R., Levin, J., Mbananga, N., & Bradshaw, D. (2002). Rape

of girls in South Africa. Lancet,359, 319-320. doi:10.1016/

S0140-6736(02)07530-X.

*Jirapramukpitak, T., Prince, M., & Harpham, T. (2005). The experi-

ence of abuse and mental health in the young Thai population—A

preliminary survey. Social Psychiatry and Psychiatric Epidemiol-

ogy,40, 955-963. doi: 10.1007/s00127-005-0983-1.

*Johnson, R. J., Ross, M. W., Taylor, W. C., Williams, M. L.,

Carvajal, R. I., & Peters, R. J. (2006). Prevalence of childhood sex-

ual abuse among incarcerated males in county jail. Child Abuse

and Neglect,30, 75-86. doi:10.1016/j.chiabu.2005.08.013.

Juffer, F., & van IJzendoorn, M. H. (2005). Behavior problems and

mental health referrals of international adoptees—A meta-analysis.

Journal of the American Medical Association,293, 2501-2515.

doi:10.1001/jama.293.20.2501.

*Jumaian, A. (2001). Prevalence and long-term impact of child sexual

abuse among a sample of male college students in Jordan. Eastern

Mediterranean Health Journal,7, 435-440.

Jumper, S. A. (1995). A meta-analysis of the relationship of child sex-

ual abuse to adult psychological adjustment. Child Abuse &

Neglect,19, 715-728. doi:10.1016/0145-2134(95)00029-8.

Kendall Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993).

Impact of sexual abuse on children—A review and synthesis of

recent empirical studies. Psychological Bulletin,113, 164-180.

doi:10.1037/0033-2909.113.1.164.

*Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., &

Prescott, C. A. (2000). Childhood sexual abuse and adult psychia-

tric and substance use disorders in women—An epidemiological

and Cotwin control analysis. Archives of General Psychiatry,57,

953-959. doi:10.1001/archpsyc.57.10.953.

*Kenny, M., & McEachern, A. G. (2000a). Prevalence and charac-

teristics of childhood sexual abuse in multiethnic female college

students. Journal of child sexual abuse,9, 57-70. doi:10.1300/

J070v09n02_04.

Kenny, M. C., & McEachern, A. G. (2000b). Racial, ethnic, and cul-

tural factors of childhood sexual abuse: A selected review of the

literature. Clinical Psychology Review,20, 905-922. doi:10.1016/

S0272-7358(99)00022-7.

*Kercher, G. A., & McShane, M. (1984). The prevalence of child sex-

ual abuse victimization in an adult sample of Texas residents.

Child Abuse and Neglect,8, 495-501. doi:10.1016/0145-2134

(84)90031-0.

*Khamis, V. (2000). Child psychological maltreatment in Palestinian

families. Child Abuse and Neglect,24, 1047-1059. doi:10.1016/

S0145-2134(00)00157-5.

*Kilpatrick, D. G., Acierno, R., Saunders, B., Resnick, H. S., &

Best, C. L. (2000). Risk factors for adolescent substance abuse and

dependence: Data from a national sample. Journal of Consulting

and Clinical Psychology,68, 19-30. doi:10.1037//0022-006X.

68.1.19.

*Kim, H. S., & Kim, H. S. (2005). Incestuous experience among Kor-

ean adolescents: Prevalence, family problems, perceived family

dynamics, and psychological characteristics. Public Health Nur-

sing,22, 472-482. doi:10.1111/j.0737-1209.2005.220604.x.

*King, G., Flisher, A. J., Noubary, F., Reece, R., Marais, A., &

Lombard, C. (2004). Substance abuse and behavioral correlates

of sexual assault among South African adolescents. Child Abuse

& Neglect,28, 683-696. doi:10.1016/j.chiabu.2003.12.003.

*King, G., Guilbert, P., Ward, D. G., Arwidson, P., & Noubary, F.

(2006). Correlates of sexual abuse and smoking among French

adults. Child Abuse & Neglect,30, 709-723. doi:10.1016/j.chiabu.

2006.02.011.

*Kinzl, J. F., Traweger, C., & Biebl, W. (1995). Sexual dysfunc-

tions—Relationship to childhood sexual abuse and early family

experiences in a nonclinical sample. Child Abuse & Neglect,19,

785-792. doi:10.1016/0145-2134(95)00048-D.

Koss, M. P. (1993). Detecting the scope of rape: A review of preva-

lence research methods. Journal of Interpersonal Violence,8,

198-222. doi:10.1177/088626093008002004.

*Krahe´, B, Scheinberger-Olwig, R., Waizenho¨ fer, E., & Kolpin, S.

(1999). Childhood sexual abuse and revictimization in adoles-

cence. Child Abuse and Neglect,23, 383-394. doi:10.1016/

S0145-2134(99)00002-2.

*Krugman, S., Mata, L., & Krugman, R. (1992). Sexual abuse and cor-

poral punishment during childhood—A pilot retrospective survey

of university-students in Costa-Rica. Pediatrics,90, 157-161.

*Kvam, M. H. (2004). Sexual abuse of deaf children. A retrospective

analysis of the prevalence and characteristics of childhood sexual

abuse among deaf adults in Norway. Child Abuse and Neglect,

28, 241-251. doi:10.1016/j.chiabu.2003.09.017.

Lalor, K. (2008). Child sexual abuse and HIV transmission in sub-

Saharan Africa. Child Abuse Review,17, 94-107. doi:10.1002/

car.1020.

*Lam, J. (1994). Resiliency and adult adaptation in females with and

without histories of childhood sexual abuse. Dissertation-

Abstracts-International,55, 1187.

96 Child Maltreatment 16(2)

by guest on February 19, 2013cmx.sagepub.comDownloaded from

*Leeners, B., Neumaier-Wagner, P., Quarg, A. F., & Rath, W. (2006).

Childhood sexual abuse (CSA) experiences: An underestimated

factor in perinatal care. Acta Obstetricia et Gynecologica Scandi-

navica,85, 971-976. doi:10.1080/00016340600626917.

*Leitenberg, H., Greenwald, E., & Cado, S. (1992). A retrospective

study of long-term methods of coping with having been sexually

abused during childhood. Child Abuse & Neglect,16, 399-407.

doi:10.1016/0145-2134(92)90049-W.

Leventhal, J. M. (1998). Epidemiology of sexual abuse of children:

Old problems, new directions. Child Abuse & Neglect,22,

481-491. doi:10.1016/S0145-2134(98)00014-3.

*Linton, S. J. (1997). A population-based study of the relationship

between sexual abuse and back pain: Establishing a link. Pain,

73, 47-53. doi:10.1016/S0304-3959(97)00071-7.

Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis.

Thousand Oaks, CA: Sage.

*Lodico, M. A., Gruber, E., & DiClemente, R. J. (1996). Childhood

sexual abuse and coercive sex among school-based adolescents

in a midwestern state. Journal of Adolescent Health,18,

211-217. doi:10.1016/1054-139X(95)00167-Q.

*Lo´pez, F., Carpintero, E., Herna´ndez, A., Martı´n, M. J., & Fuertes, A.

(1995). Prevalencia y Consecuencias del Abuso Sexual al Menor

en Espana [Prevalence and consequences of child sexual abuse

in Spain]. Child Abuse and Neglect,19, 1039-1050. doi:10.1016/

0145-2134(95)00066-H.

*Lopez, M. A., & Heffer, R. W. (1998). Self-concept and social com-

petence of university student victims of childhood physical abuse.

Child Abuse and Neglect,22, 183-195. doi:10.1016/S0145-2134

(97)00136-1.

*Mackenzie, G., Blaney, R., Chivers, A., & Vincent, O. E. (1993). The

incidence of child sexual abuse in Northern-Ireland. International

Journal of Epidemiology,22, 299-305. doi:10.1093/ije/22.2.299.

Madu, S. N., & Peltzer, K. (2000). Risk factors and child sexual abuse

among secondary school students in the Northern Province

(South Africa). Child Abuse & Neglect,24, 259-268. doi:10.1016/

S0145-2134(99)00128-3.

*Madu, S. N. (2001). The prevalence and patterns of childhood sexual

abuse and victim-perpetrator relationship among a sample of uni-

versity students. South African Journal of Psychology,31, 32-37.

*Madu, S. N. (2003). The relationship between parental physical

availability and child sexual, physical and emotional abuse:

A study among a sample of university students in South Africa.

Scandinavian Journal of Psychology,44, 311-318. doi:10.1111/

1467-9450.00350.

*Madu, S. N., & Peltzer, K. (2001). Prevalence and patterns of child

sexual abuse and victim-perpetrator relationship among secondary

school students in the Northern Province (South Africa). Archives

of Sexual Behavior,30, 311-321. doi: 10.1023/A:1002704331364.

*Mamun, A., Alati, R., O’Callaghan, M., Hayatbakhsh, M. R.,

O’Callaghan, F. V., Najman, J. M., & ... Bor, W. (2007). Does

childhood sexual abuse have an effect on young adults’ nicotine

disorder (dependence or withdrawal)? Evidence from a birth

cohort study. Addiction,102, 647-654. doi:10.1111/j.1360-0443.

2006.01732.x.

*Mandell, D. S., Walrath, C. M., Manteuffel, B., Sgro, G., & Pinto-

Martin, J. A. (2005). The prevalence and correlates of abuse among

children with autism served in comprehensive community-based

mental health settings. Child Abuse and Neglect,29, 1359-1372.

doi:10.1016/j.chiabu.2005.06.006.

*Masho, S. W., & Ahmed, G. (2007). Age at sexual assault and post-

traumatic stress disorder among women: Prevalence, correlates,

and implications for prevention. Journal of Womens Health,16,

262-271. doi:10.1089/jwh.2006.M076.

*May-Chahall, C., & Cawson, P. (2005). Measuring child maltreat-

ment in the United Kingdom: A study of the prevalence of child

abuse and neglect. Child Abuse and Neglect,29, 969-984.

doi:10.1016/j.chiabu.2004.05.009.

*Mazza, D., Dennerstein, L., & Ryan, V. (1996). Physical, sexual and

emotional violence against women: A general practice-based pre-

valence study. Medical Journal of Australia,164, 14-17.

*Mazza, D., Dennerstein, L., Garamszegi, C. V., & Dudley, E. C.

(2001). The physical, sexual and emotional violence history of

middle-aged women: A community-based prevalence study. Med-

ical Journal of Australia,175, 199-201.

Mbagaya, C. V. (2010). Child maltreatment in Kenia, Zambia and the

Netherlands. A cross-cultural comparison of prevalence, psycho-

pathological sequelae, and mediation by PTSS. Leiden: Drukkerij

Mostert.

*McCrann, D., & Lalor, K. J. K. (2006). Childhood sexual abuse

among university students in Tanzania. Child Abuse and Neglect,

30, 1343-1351. doi:10.1016/j.chiabu.2006.05.009.

*Mcnutt, L. A., Carlson, B. E., Persaud, M., & Postmus, J. (2002).

Cumulative abuse experiences, physical health and health beha-

viors. Annals of Epidemiology,12, 123-130. doi:10.1016/S1047-

2797(01)00243-5.

*Menard, C., Bandeen-Roche, K. J., & Chilcoat, H. D. (2004).

Epidemiology of multiple childhood traumatic events: child abuse,

parental psychopathology, and other family-level stressors. Social

Psychiatry and Psychiatric Epidemiology,39, 857-865. doi:10.1007/

s00127-004-0868-8.

*Merrill, L. L., Newell, C. E., Thomsen, C. J., Gold, S. R., Milner, J.

S., Koss, M. P., & Rosswork, S. G. (1999). Childhood abuse and

sexual revictimization in a female navy recruit sample. Journal

of Traumatic Stress,12, 211-225. doi:10.1023/A:1024789723779.

*Messman-Moore, T. L. (2000). Child sexual abuse and revictimiza-

tion in the form of adult sexual abuse, adult physical abuse,

and adult psychological maltreatment. Journal of Interpersonal

Violence,15, 489-502. doi:10.1177/088626000015005003.

*Meston, C. M., Heiman, J. R., Trapnell, P. D., & Carlin, A. S. (1999).

Ethnicity, desirable responding, and self-reports of abuse: A com-

parison of European- and Asian-ancestry undergraduates. Journal

of Consulting and Clinical Psychology,67, 139-144. doi:10.1037//

0022-006X.67.1.139.

*Miller, P. M., & Lisak, D. (1999). Associations between childhood

abuse and personality disorder symptoms in college males. Journal

of Interpersonal Violence,14, 642-656. doi:10.1177/0886260

99014006005.

*Milner, J. S. (1990). Childhood history of abuse and adult child abuse

potential. Journal of Family Violence,5, 15-34. doi:10.1007/

BF00979136.

*Mulder, R. T., Beautrais, A. L., Joyce, P. R., & Fergusson, D. M.

(1998). Relationship between dissociation, childhood sexual

Stoltenborgh et al. 97

by guest on February 19, 2013cmx.sagepub.comDownloaded from

abuse, childhood physical abuse, and mental illness in a general

population sample. American Journal of Psychiatry,155, 806-811.

*Mullen, P. E., Romans-Clarkson, S. E., Walton, V. A., & Herbison, G.

P. (1988). Impact of sexual and physical abuse on women’s mental

health. Lancet,1, 841-845. doi:10.1016/S0140-6736(88)91600-5.

*Muram, D., Dorko, B., Brown, J. G., & Tolley, E. A. (1991). Child

sexual abuse in Shelby County, Tennessee—A new epidemic.

Child Abuse & Neglect,15(91), 523-529. doi:10.1016/0145-2134

(95)90036-D.

*Nelson, D. E., Higginson, G. K., & Grant-Worley, J. A. (1994). Using

the youth risk behavior survey to estimate prevalence of sexual

abuse among Oregon high school students. The Journal of School

Health,64, 413-416. doi:10.1111/j.1746-1561.1994.tb03264.x.

*Nelson, E. C., Heath, A. C., Lynskey, M. T., Bucholz, K. K.,

Madden, P. A. F., Statham, D. J., & Martin, N. G. (2006). Child-

hood sexual abuse and risks for licit and illicit drug-related out-

comes: A twin study. Psychological Medicine,36, 1473-1483.

doi:10.1017/S0033291706008397.

*Niederberger, J. M. (2002). The perpetrator’s strategy as a crucial

variable: A representative study of sexual abuse of girls and its

sequelae in Switzerland. Child Abuse & Neglect,26, 55-71.

doi:10.1016/S0145-2134(01)00303-9.

*Nuttall, R., & Jackson, H. (1994). Personal history of childhood

abuse among clinician. Child Abuse & Neglect,18, 455-472.

doi:10.1016/0145-2134(94)90030-2.

*Oaksford, K., & Frude, N. (2001). The prevalence and nature of child

sexual abuse: Evidence from a female university sample in the UK.

Child Abuse Review,10, 49-59. doi:10.1002/car.663.

O’Leary, P. J., & Barber, J. (2008). Gender differences in silencing

following childhood sexual abuse. Journal of child sexual abuse,

17, 133-143. doi:10.1080/10538710801916416.

*Olsson, A., Ellsberg, M., Berglund, S., Herrera, A., Zelaya, E.,

Pen

˜a, R., & ... Persson, L. A. (2000). Sexual abuse during child-

hood and adolescence among Nicaraguan men and women: A

population-based anonymous survey. Child Abuse and Neglect,

24, 1579-1589. doi:10.1016/S0145-2134(00)00215-5.

Paolucci, E. O., Genuis, M. L., & Violato, C. (2001). A meta-

analysis of the published research on the effects of child sexual

abuse. Journal of Psychology,135, 17-36. doi:10.1080/002239

80109603677.

*Parker, S., & Parker, H. (1991). Female victims of child sexual

abuse: Adult adjustment. Journal of Family Violence,6,

183-197. doi:10.1007/BF00978718.

Pereda, N., Guilera, G., Forns, M., & Gomez-Benito, J. (2009a). The

international epidemiology of child sexual abuse: A continuation

of Finkelhor (1994). Child Abuse & Neglect,33, 331-342.

doi:10.1016/j.chiabu.2008.07.007.

Pereda, N., Guilera, G., Forns, M., & Gomez-Benito, J. (2009b). The

prevalence of child sexual abuse in community and student sam-

ples: A meta-analysis. Clinical Psychology Review,29, 328-338.

doi:10.1016/j.cpr.2009.02.007.

*Peschers, U. M., Du Mont, J., Jundt, K., Pfu

¨rtner, M., Dugan, E., &

Kindermann, G. (2003). Prevalence of sexual abuse among women

seeking gynecologic care in Germany. The American College of

Obstetricians and Gynecologists,101, 103-108. doi:10.1016/

S0029-7844(02)02248-2.

*Peters, D. K., & Range, L. M. (1995). Childhood sexual abuse and

current suicidality in college women and men. Child Abuse and

Neglect,19, 335-341. doi:10.1016/S0145-2134(94)00133-2.

Peters, S. D., Wyatt, G. E., & Finkelhor, D. (1986). Prevalence. In

D. Finkelhor (Ed.), A sourcebook on child sexual abuse,

(pp. 15-59). Beverly Hills, CA: Sage.

*Pizzolo, C. P. (1989). The Relationship between childhood sexual

abuse and symptoms of eating disorders among college women.

Stony Brook, NY: State University of New York.

Posada, G., Gao, Y., Wu, F., Posada, R., Tascon, M., Schoe¨lmerich, A.,

&... Synnevaag, B. (2008). The secure-base phenomenon across

cultures: Children’s behavior, mothers’ preferences, and experts’

concepts. Monographs of the Society for Research in Child Develop-

ment,60, 27-48. doi:10.2307/1166169.

*Priest, R. (1992). Child sexual abuse histories among African-

American college-students—A preliminary study. American Jour-

nal of Orthopsychiatry,62, 475-476. doi:10.1037/h0079353.

Putnam, F. W. (2003). Ten-year research update review: Child sexual

abuse. Journal of the American Academy of Child & Adolescent Psy-

chiatry,42, 269-278. doi:10.1097/00004583-200303000-00006.

*Raiha, N. K., & Soma, D. J. (1997). Victims of child abuse and

neglect in the U.S. Army. Child Abuse and Neglect,21, 759-768.

doi:10.1016/S0145-2134(97)00037-9.

*Ramisetty-Mikler, S., Caetano, R., Goebert, D., & Nishimura, S.

(2006). Dating violence victimization: Associated drinking and

sexual risk behaviors of Asian, native Hawaiian, and Caucasian

high school students in Hawaii. Journal of School Health,76,

423-429. doi:10.1111/j.1746-1561.2006.00136.x.

*Rapkin, A. J., Kames, L. D., Darke, L. L., Stampler, F. M., &

Naliboff, B. D. (1990). History of physical and sexual abuse in

women with chronic pelvic pain. Obstetrics and Gynecology,76,

92-96. doi:10.1016/0020-7292(91)90368-F.

*Rew, L., Esparza, D., & Sands, D. (1991). A comparative study

among college students of sexual abuse in childhood. Archives

of Psychiatric Nursing,5, 331-340. doi:10.1016/0883-9417(91)

90034-3.

*Riggs, S., Alario, A. J., & Mchorney, C. (1990). Health risk beha-

viors and attempted-suicide in adolescents who report prior mal-

treatment. Journal of Pediatrics,116, 815-821. doi:10.1016/

S0022-3476(05)82679-4.

Rind, B., Tromovitch, P., & Bauserman, R. (1998). A meta-analytic

examination of assumed properties of child sexual abuse using col-

lege samples. Psychological Bulletin,124, 22-53. doi:10.1037//

0033-2909.124.1.22.

*Risberg, G., Lundgren, E., & Westman, G. (1999). Prevalence of sex-

ualized violence among women: A population-based study in a pri-

mary healthcare district. Scandinavian Journal of Public Health,

27, 247-253. doi:10.1080/140349499444979.

*Risin, L. I., & Koss, M. P. (1987). The sexual abuse of boys. Journal

of Interpersonal Violence,2, 309-323. doi:10.1177/08862608700

2003006.

*Robin, R. W., Chester, B., Rasmussen, J. K., Jaranson, J. M., &

Goldman, D. (1997). Prevalence, characteristics, and impact of

childhood sexual abuse in a southwestern American Indian tribe.

Child Abuse & Neglect,21, 769-787. doi:10.1016/S0145-2134

(97)00038-0.

98 Child Maltreatment 16(2)

by guest on February 19, 2013cmx.sagepub.comDownloaded from

Romano, E., & De Luca, R. V. (2001). Male sexual abuse: A review of

effects, abuse characteristics, and links with later psychologicalfunc-

tioning. Aggression and Violent Behaviour,6, 55-78. doi:10.1016/

S1359-1789(99)00011-7.

*Romero, G., Wyatt, G. E., Loeb, T. B., Vargas Carmona, J., &

Solis, B. M. (1999). The prevalence and circumstances of child

sexual abuse among Latina women. Hispanic Journal of Beha-

vioral Sciences,21, 351-365. doi:10.1177/0739986399213009.

*Roosa, M. W., Tein, J. Y., Reinholtz, C., & Angelini, P. J. (1997).

The relationship of childhood sexual abuse to teenage pregnancy.

Journal of Marriage and the Family,59, 119-130. doi:10.2307/

353666.

*Rosen, L. N., & Martin, L. (1996). Impact of childhood abuse history

on psychological symptoms among male and female soldiers in the

US army. Child Abuse & Neglect,20, 1149-1160. doi:10.1016/

S0145-2134(96)00112-3.

*Rosenberg, H. J., Jankowski, M. K., Sengupta, A., Wolfe, R. S.,

Wolford, G. L., & Rosenberg, S. D. (2005). Single and multiple

suicide attempts and associated health risk factors in New Hamp-

shire adolescents. Suicide and Life-Threatening Behavior,35,

547-557. doi:10.1521/suli.2005.35.5.547.

*Rosenman, S., & Rodgers, B. (2004). Childhood adversity in an

Australian population. Social Psychiatry and Psychiatric Epide-

miology,39, 695-702. doi:10.1007/s00127-004-0802-0.

Rosenthal, R. (1991). Meta-analytic procedures for social research.

Newbury Park, CA: Sage.

*Ross, C. A., Keyes, B. B., Xiao, Z., Yan, H., Wang, Z., Zou, Z., &

... Zhang, H. (2005). Childhood physical and sexual abuse in

China. Journal of Child Sexual Abuse,14, 115-126. doi:10.1300/

J070v14n04_06.

Rothbart, M. K. (1981). Measurement of temperament in infancy.

Child Development,52, 569-578. doi:10.1111/j.1467-8624.1981.

tb03082.x.

*Runtz, M. (2002). Health concerns of university women with a his-

tory of child physical and sexual maltreatment. Child Maltreat-

ment,7, 241-253. doi:10.1177/1077559502007003006.

Runyan, D. K. (1998). Prevalence, risk, sensitivity, and specificity: A

commentary on the epidemiology of child sexual abuse and the

development of a research agenda. Child Abuse & Neglect,22,

493-498. doi:10.1016/S0145-2134(98)00015-5.

*Russell, D. E. H. (1983). The incidence and prevalence of intrafami-

lial and extrafamilial sexual abuse of female children. Child Abuse

& Neglect,7, 133-146. doi:10.1016/0145-2134(83)90065-0.

*Sachs-Ericsson, N., Blazer, D., Plant, E. A., & Arnow, B. (2005).

Childhood sexual and physical abuse and the 1-year prevalence

of medical problems in the National Comorbidity Survey. Health

Psychology,24, 32-40. doi:10.1037/0278-6133.24.1.32.

*Sandberg, D. A., & Lynn, S. J. (1992). Dissociative experiences, psy-

chopathology and adjustment, and child and adolescent maltreat-

ment in female college-students. Journal of Abnormal

Psychology,101, 717-723. doi:10.1037//0021-843X.101.4.717.

*Sariola, H., & Uutela, A. (1994). The prevalence of child sexual

abuse in Finland. Child Abuse & Neglect,18, 827-835.

doi:10.1016/0145-2134(94)90062-0.

*Saunders, B. E., Villeponteaux, L. A., Lipovsky, J. A., Kilpatrick, D.

G., & Veronen, L. J. (1992). Child sexual assault as a risk factor for

mental-disorders among women—A community survey. Journal

of Interpersonal Violence,7, 189-204. doi:10.1177/08862609200

7002005.

*Schei, B. (1990). Prevalence of sexual abuse history in a random

sample of Norwegian women. Scandinavian Journal of Social

Medicine,18, 63-68. doi:10.1177/140349489001800110.

*Schein, M., Biderman, A., Baras, M., Bennett, L., Bisharat, B.,

Borkan, J., & ... Kitai, E. (2000). The prevalence of a history

of child sexual abuse among adults visiting family practitioners

in Israel. Child Abuse & Neglect,24, 667-675. doi:10.1016/

S0145-2134(00)00128-9.

*Scher, C. D., Forde, D. R., McQuaid, J. R., & Stein, M. B. (2004).

Prevalence and demographic correlates of childhood maltreatment

in an adult community sample. Child Abuse and Neglect,28,

167-180. doi:10.1016/j.chiabu.2003.09.012.

*Schultz, J. R., Bell, K. M., Naugle, A. E., & Polusny, M. A. (2006).

Child sexual abuse and adulthood sexual assault among military

veteran and civilian women. Military Medicine,171, 723-728.

Sedlak, A. J. (2001). A history of the National Incidence study of child

abuse and neglect. Washington, DC: U.S. Department of Health

and Human Services.

*Sedney, M. A., & Brooks, B. (1984). Factors associated with a history

of childhood sexual experience in a nonclinical female population.

Journal of the American Academy of Child and Adolescent Psychia-

try,23, 215-218. doi:10.1097/00004583-198403000-00015.

*Sidebotham, P., & Golding, J. (2001). Child maltreatment in the

‘‘children of the nineties’’: A longitudinal study of parental risk

factors. Child Abuse and Neglect,25, 1177-1200. doi:10.1016/

S0145-2134(01)00261-7.

*Siegel, J. M., Sorenson, S. B., Golding, J. M., Burnam, M. A., &

Stein, J. A. (1987). The prevalence of childhood sexual assault—

The Los Angeles epidemiologic catchment area project. American

Journal of Epidemiology,126, 1141-1153.

*Silverman, A. B., Reinherz, H. Z., & Giaconia, R. M. (1996). The

long-term sequelae of child and adolescent abuse: A longitudinal

community study. Child Abuse & Neglect,20, 709-723.

doi:10.1016/0145-2134(96)00059-2.

*Silvern, L., Waelde, L. C., McClintic Baughan, B., & Kaersvang, L.

L. (2000). Two formats for eliciting retrospective reports of child

sexual and physical abuse: Effects on apparent prevalence and

relationships to adjustment. Child Maltreatment,5, 236-250.

doi:10.1177/1077559500005003004.

*Singh, H. S. S. A., Yiing, W. W., & Nurani, H. N. K. (1996). Preva-

lence of childhood sexual abuse among Malaysian paramedical

students. Child Abuse & Neglect,20, 487-492. doi:10.1016/

0145-2134(96)00030-0.

*Slonim-Nevo, V., & Mukuka, L. (2007). Child abuse and AIDS-

related knowledge, attitudes and behavior among adolescents in

Zambia. Child Abuse & Neglect,31, 143-159. doi:10.1016/

j.chiabu.2006.08.006.

*Spak, L., Spak, F., & Allebeck, P. (1998). Sexual abuse and alcohol-

ism in a female population. Addiction,93, 1365-1373. doi:10.1046/

j.1360-0443.1998.93913657.x.

Spatz Widom, C., Czaja, S., & Dutton, M. (2008). Childhood victimi-

zation and lifetime revictimization. Child Abuse & Neglect,32,

785-796. doi:10.1016/j.chiabu.2007.12.006.

Stoltenborgh et al. 99

by guest on February 19, 2013cmx.sagepub.comDownloaded from

Spatz Widom, C., DuMont, K., & Czaja, S. (2007). A prospective

investigation of major depressive disorder and comorbidity in

abused and neglected children grown up. Archives of General

Psychiatry,64, 49-56. doi:10.1001/archpsyc.64.1.49.

*Spencer, N., Devereux, E., Wallace, A., Sundrum, R., Shenoy, M.,

Bacchus, C., & ... Logan, S. (2005). Disabling conditions and

registration for child abuse and neglect: A population-based study.

Pediatrics,116, 609-613. doi:10.1542/peds.2004-1882.

*Steel, J. L., & Herlitz, C. A. (2005). The association between child-

hood and adolescent sexual abuse and proxies for sexual risk beha-

vior: A random sample of the general population of Sweden. Child

Abuse & Neglect,29, 1141-1153. doi:10.1016/j.chiabu.2004.

10.015.

*Stein, M. B., Walker, J. R., Anderson, G., Hazen, A. L., Ross, C. A.,

Eldridge, G., & Forde, D. R. (1996). Childhood physical and sex-

ual abuse in patients with anxiety disorders and in a community

sample. American Journal of Psychiatry,153, 275-277.

*Stenson, K., Heimer, G., Lundh, C., Nordstro¨m, M. L., Saarinen, H.,

& Wenker, A. (2003). Lifetime prevalence of sexual abuse in

a Swedish pregnant population. Acta Obstetetrica et Gynecolo-

gica Scandinavica,82, 529-536. doi:10.1034/j.1600-0412.2003.

00111.x.

Sutton, A. J., Duval, S. J., Tweedie, R. L., Abrams, K. R., & Jones, D.

R. (2000). Empirical assessment of effect of publication bias on

meta-analyses. British Medical Journal,320, 1574-1577. doi:10.1136

/bmj.320.7249.1574.

*Tang, C. S. K. (2002). Childhood experience of sexual abuse among

Hong Kong Chinese college students. Child Abuse and Neglect,26,

23-37. doi:10.1016/S0145-2134(01)00306-4.

*Thakkar, R. R., Gutierrez, P. M., Kuczen, C. L., & McCanne, T. R.

(2000). History of physical and/or sexual abuse and current suicid-

ality in college women. Child Abuse and Neglect,24, 1345-1354.

doi:10.1016/S0145-2134(00)00187-3.

*Theodore, A., Chang, J. J., Runyan, D. K., Hunter, W. M.,

Bangdiwala, S. I., & Agans, R. (2005). Epidemiologic features

of the physical and sexual maltreatment of children in the Caroli-

nas. Pediatrics,115, 331-337. doi:10.1542/peds.2004-1033.

*Thompson, M. P., Arias, I., Basil, C., & Desai, S. (2002). The asso-

ciation between childhood physical and sexual victimization and

health problems in adulthood in a nationally representative sample

of women. Journal of Interpersonal Violence,17, 1115-1128.

doi:10.1177/088626002236663.

*Thompson, M. P., Kaslow, N. J., Lane, D. B., & Kingree, J. B.

(2000). Childhood maltreatment, PTSD and suicidal behavior

among African American females. Journal of Interpersonal Vio-

lence,15, 3-15. doi:10.1177/088626000015001001.

*Tomeo, M. E., Templer, D. I., Anderson, S., & Kotler, D. (2001).

Comparative data of childhood and adolescence molestation in het-

erosexual and homosexual persons. Archives of Sexual Behavior,

30, 535-541. doi: 10.1023/A:1010243318426.

*Trocme´, N. M, Tourigny, M., MacLaurin, B., & Fallon, B. (2003).

Major findings from the Canadian incidence study of reported

child abuse and neglect. Child Abuse and Neglect,27,

1427-1439. doi:10.1016/j.chiabu.2003.07.003.

*Tschumper, A., Narring, F., Meier, C., & Michaud, P. A. (1998).

Sexual victimization in adolescent girls (age 15-20 years) enrolled

in post-mandatory schools or professional training programmes in

Switzerland. Acta Paediatrica,87, 212-217. doi:10.1080/0803525

9850157697.

United Nations (1989). Convention on the rights of the child.

Retrieved from http://www2.ohchr.org/english/law/pdf/crc.pdf

Valentine, J. C., Pigott, T. D., & Rothstein, H. R. (2010). How many

studies do you need? A primer on statistical power for meta-anal-

ysis. Journal of Educational and Behavioral Statistics,35,

215-247. doi: 10.3102/1076998609346961.

Van IJzendoorn, M. H. (2007). De vragenlijst voorbij: schets van

onderzoek naar kindermishandeling. Pedagogiek,27, 236-243.

Van IJzendoorn, M. H., Prinzie, P., Euser, E. M., Groeneveld, M. G.,

Brilleslijper-Kater, S. N., van Noort-van der Linden, A. M. T., &

... San Martin Beuk, M. (2007). De Nationale Prevalentiestudie

Mishandeling van Kinderen en Jeugdigen (NPM-2005). [National

prevalence study of child maltreatment]. Leiden: Casimir.

Van Os, J., Linscott, R. J., Myin-Germeys, I., Delespaul, P., &

Krabbendam, L. (2009). A systematic review and meta-analysis

of the psychosis continuum: Evidence for a psychosis proneness-

persistence-impairment model of psychotic disorder. Psychologi-

cal Medicine,39, 179-195. doi:10.1017/S0033291708003814.

*Vogeltanz, N. D., Wilsnack, S. C., Harris, T. R., Wilsnack, R. W.,

Wonderlich, S. A., & Kristjanson, A. F. (1999). Prevalence and

risk factors for childhood sexual abuse in women: national survey

findings. Child Abuse and Neglect,23, 579-592. doi:10.1016/

S0145-2134(99)00026-5.

*Wellman, M. M. (1993). Child sexual abuse and gender differences:

Attitudes and prevalence. Child Abuse and Neglect,17, 539-547.

doi:10.1016/0145-2134(93)90028-4.

*Wind, T. W., & Silvern, L. (1992). Type and extent of child-abuse as

predictors of adult functioning. Journal of Family Violence,7,

261-281. doi:10.1007/BF00994618.

*Wingood, G. M., & DiClemente, R. J. (1997). Child sexual abuse,

HIV sexual risk, and gender relations of African-American

women. American Journal of Preventive Medicine,13, 380-384.

*Wonderlich, S. A., Wilsnack, R. W., Wilsnack, S. C., & Harris, T. R.

(1996). Childhood sexual abuse and bulimic behavior in a nation-

ally representative sample. American Journal of Public Health,86,

1082-1086. doi:10.2105/AJPH.86.8_Pt_1.1082.

*Worku, D., Gebremariam, A., & Jayalakshmi, S. (2006). Child sex-

ual abuse and its outcomes among high school students in south-

west Ethiopia. Tropical Doctor,36, 137-140. doi:10.1258/00494

7506777978325.

World Health Organization. (1999). Report of the Consultation on Child

Abuse Prevention, 29-31 March 1999, WHO, Geneva. Geneva:

Author.

Wyatt, G. E. & Peters, S. D. (1986). Methodological considerations in

research on the prevalence of child sexual abuse. Child Abuse &

Neglect,10, 241-251. doi:10.1016/0145-2134(86)90085-2.

*Wyatt, G. E. (1985). The sexual abuse of Afro-American and White-

American women in childhood. Child Abuse and Neglect,9,

507-519. doi:10.1016/0145-2134(85)90060-2.

*Wyatt, G. E., Loeb, T. B., Solis, B., Vargas Carmona, J., &

Romero, G. (1999). The prevalence and circumstances of child

sexual abuse: Changes across a decade. Child Abuse and Neglect,

23, 45-60. doi:10.1016/S0145-2134(98)00110-0.

100 Child Maltreatment 16(2)

by guest on February 19, 2013cmx.sagepub.comDownloaded from

*Young, S. Y. N., Hansen, C. J., Gibson, R. L., & Ryan, M. A. K.

(2006). Risky alcohol use, age at onset of drinking, and adverse

childhood experiences in young men entering the US Marine

Corps. Archives of Pediatrics & Adolescent Medicine,160,

1207-1214. doi:10.1001/archpedi.160.12.1207.

*Zetzer, H. A. (1990). The impact of unwanted childhood sexual

experiences and the quality of family life on the psychosexuality

of college women. Dissertation-Abstracts-International, 12),

6122-51.

Stoltenborgh et al. 101

by guest on February 19, 2013cmx.sagepub.comDownloaded from

The Relationship Between Offense-Supportive Cognitions and Childhood Trauma in Offending and Non-Offending Men with (Exclusive) Pedo-, Hebe-, and Teleiophilia Who Seek Voluntary Treatment

Article

Full-text available

Mar 2025
DEVIANT BEHAV

Neural activation during processing of emotional faces as a function of resilience in adolescents

Article

Full-text available

Apr 2025
EUR CHILD ADOLES PSY

Neuroimaging studies suggest that resilience to adversity is linked to reduced emotional reactivity or enhanced emotion regulation. However, such studies are scarce and mainly use adult samples and categorical definitions of resilience. Using a novel, data-driven approach to define resilience dimensionally, based on cumulative adversity exposure across childhood and psychopathology, we investigated associations between resilience and brain activation during facial emotion processing in youth. We also tested for sex differences in the relationship between resilience and brain activation. fMRI data were acquired from 208 youths (aged 9–18 years; Mean age = 13.28), while viewing angry, fearful, and neutral faces. Whole-brain analyses were performed, followed by region-of-interest analyses focusing on the amygdala, hippocampus, and prefrontal cortex. Resilience was positively correlated with bilateral inferior frontal gyrus responses to fearful (versus neutral) faces, and negatively correlated with right superior temporal gyrus, left hippocampal, and right inferior frontal gyrus responses to neutral faces (versus fixation). Sex-by-resilience interactions were observed in the medial prefrontal cortex: males showed positive, while females showed negative, associations between resilience and brain activation, though these results did not survive correction for multiple comparisons. These findings provide further evidence that resilience in youth is associated with enhanced emotion regulation at a neural level.

Dynamic Changes of Serotonin Transporter Expression in the Prefrontal Cortex Evoked by Aggressive Social Interactions

Article

Full-text available

Mar 2025

Aggression is a complex behavior influenced by developmental experiences, internal state, and social context, yet its neurobiological underpinnings remain insufficiently understood. The serotonergic system, particularly the serotonin transporter (SERT), plays a crucial role in aggression regulation. Here, we investigated region-specific, dynamic changes in SERT expression following aggressive interactions and in mice subjected to early-life social adversity. We found that aggressive encounters (resident-intruder test) triggered a significant, rapid increase in SERT immunoreactivity within 90 min, accompanied by neuronal activation in aggression-related brain regions, including the medial prefrontal cortex (mPFC), lateral septum (LS), medial amygdala (MeA), ventromedial hypothalamus (VMHvl), lateral habenula (LH), and dorsal raphe (DR), but not in the paraventricular thalamus (PVT). Notably, this SERT upregulation occurred across the aggression circuitry but was accompanied by a significant increase in 5-HT levels only in the mPFC, a key region in top-down regulation of social and aggressive behavior. This SERT upregulation was not observed following exposure to a non-social challenge, suggesting that it may be more specifically associated with social contexts. Using super-resolution microscopy, we identified an increased density of SERT localization points within serotonergic mPFC axons after an aggressive encounter. Social isolation during adolescence, a model of early social neglect, impaired this rapid SERT response, particularly in the ventral and medial orbitofrontal regions, and altered the relationship between SERT levels and aggression-related behaviors. These findings demonstrate that SERT expression undergoes rapid, experience-dependent plasticity in response to social aggression, and that early-life adversity disrupts this adaptive mechanism, providing new insights into the serotonergic regulation of aggression and its potential relevance for stress-related social dysfunctions.

Barriers and Facilitators for Sexual Trauma Disclosure in Boys and Men: A Systematic Review

Article

Mar 2025
TRAUMA VIOLENCE ABUS

Disclosing sexual trauma can support recovery and healing for victim-survivors. Despite evidence indicating low disclosure rates and long disclosure delays in sexual trauma-exposed boys and men, little is known about factors impacting disclosure in this group. A systematic review was conducted to consolidate evidence surrounding barriers, facilitators, and predictors of disclosure likelihood and timing in boys and men following sexual trauma (i.e., sexual abuse, assaults, and coercion). Disclosure included formal reporting, help-seeking, and discussions with social supports. Four electronic databases (PsycINFO, CINAHL, SCOPUS, and Medline) were searched and 69 articles (42 qualitative, 25 quantitative, two mixed-methods) were included, representing 10,517 sexual trauma-exposed boys and men and 297 supports of sexual trauma-exposed boys and men (e.g., police, mental health practitioners). Barriers and facilitators were mapped according to levels of the social ecology. Boys’ and men’s understanding of, and responses to, sexual trauma were informed by perceived masculine norm violations and minimal public acknowledgement and validation of their trauma. These factors were compounded by a dearth of appropriate supports and practitioner knowledge. Assessed predictors of disclosure outcomes were highly variable, indicating limited theoretical understanding of factors likely to impact disclosure and need for greater methodological rigor and integration of theory into this domain. Scholarship remains biased towards disclosure barriers, with little emphasis on strengths-based factors that support help-seeking. Findings highlight impacts of gender socialisation processes on long-term experiences of sexual trauma. Implications for practice, policy, and research are discussed, including need for greater awareness and support for sexual trauma-exposed boys and men.

Shadows of doubt: Ambivalent acknowledgment of abuse and identification with the aggressor

Article

Full-text available

Mar 2025

"We Heal Together": Characteristics of the Male Healing Journey from Childhood Sexual Abuse Among Men in Recovery from Substance Use Disorder in the United States

Article

Apr 2025
J Child Sex Abuse

Barriers to and facilitators of self-disclosure by male victims of child sexual abuse: a rapid review

Article

Apr 2025
CHILD YOUTH SERV REV

A Pilot Study of the Child and Family Traumatic Stress Intervention

Article

Apr 2025
Child Care Pract

Adolescent Suicidal Behaviours and Child Sexual Abuse: Risk Factors, Protective Factors, and Treatment Recommendations

Chapter

Apr 2025

Research has shown that child sexual abuse (CSA) is related to suicidal behaviors in adolescence, a period in which suicide is the second leading cause of death in the U.S. Moreover, compared to other adverse childhood experiences, CSA is most consistently and strongly associated to adolescent suicidality. This highlights the urgency of assessment and treatment of survivors of CSA for suicide prevention. Not all survivors of CSA develop suicidality in adolescence. Knowing the risk and protective factors can help clinicians better assess the likelihood of suicidality after CSA exposure. Common risk factors include CSA by an immediate family member, being older when CSA occurred, disruption of family environment, harmful caregiver reactions, having a mental health diagnosis, higher levels of impulsivity, and contact abuse. There is less research on protective factors than risk factors. Nonetheless, studies have shown that family support and connectedness are strong protective factors. Other protective factors include active coping, social attachment, external attribution of blame, etc. Additionally, understanding pathways from CSA exposure to suicidality is paramount for treatment. Preliminary research points to self-blame, shame, and avoidance coping as potential mechanisms. Thus, focusing on shifting the pathways can be helpful in reducing suicidality, in addition to addressing risk and protective factors and utilizing general suicide prevention protocols. This chapter will explore the relationship between CSA and adolescent suicidality, risk and protective factors, and provide treatment recommendations for suicide prevention.

References

Chapter

Apr 2025

Diarmuid Griffin

Forced Sexual Intercourse and Associated Health-Risk Behaviors Among Female College Students in the United States

Article

Full-text available

Apr 1999

This study analyzed data from the 1995 National College Health Risk Behavior Survey (NCHRBS) to assess the prevalence of lifetime rape among female college students and to examine the association between rape and health-risk behaviors. The NCHRBS used a mail questionnaire to assess health-risk behaviors among a nationally representative sample of undergraduate students. Twenty percent of female students reported ever having been forced to have sexual intercourse, most often during adolescence. When analyses controlled for demographic characteristics, female students who had ever been raped were significantly more likely than those who had not to report a wide range of health-risk behaviors. These results highlight a need to improve rape prevention and treatment programs for female adolescents.

Impact of Sexual Abuse on Children: A Review and Synthesis of Recent Empirical Studies

Article

Full-text available

Jan 1993

A review of 45 studies clearly demonstrated that sexually abused children had more symptoms than nonabused children, with abuse accounting for 15–45% of the variance. Fears, posttraumatic stress disorder, behavior problems, sexualized behaviors, and poor self-esteem occurred most frequently among a long list of symptoms noted, but no one symptom characterized a majority of sexually abused children. Some symptoms were specific to certain ages, and approximately one third of victims had no symptoms. Penetration, the duration and frequency of the abuse, force, the relationship of the perpetrator to the child, and maternal support affected the degree of symptomatology. About two thirds of the victimized children showed recovery during the first 12–18 months. The findings suggest the absence of any specific syndrome in children who have been sexually abused and no single traumatizing process.

A STUDY ON THE INFORMATION TRANSFER AND LONG-TERM PSYCHOLOGICAL IMPACT OF CHILD SEXUAL ABUSE

Article

Mar 2024

Meta-Analytic Procedures for Social Research

Book

Jan 1991

Robert Rosenthal

Childhood Sexual Abuse: An Evidence Based Perspective

Book

Jan 1999

Prevalence of childhood sexual abuse in a community sample of Australian women

Article

Jun 1997

Julian M Fleming

Prevalence of childhood sexual abuse in a community sample of Australian women

Article

Jan 1997

Jillian M Fleming

Objective To ascertain the prevalence of childhood sexual abuse (CSA) in a community sample of Australian women. Design Retrospective study, done in 1994, of cross‐sectional data on the prevalence of CSA, collected as part of a larger two‐stage case‐control study of the possible relationship between CSA and alcohol abuse. Data were appropriately weighted to adjust for the different selection probabilities of cases and controls. Participants 710 Women randomly selected from Australian federal electoral rolls. Results • One hundred and forty‐four women (20%) had experienced CSA. • In 14 of these 144 women (10%), the abuse involved either vaginal or anal intercourse (i.e., 2% of the sample population experienced such abuse). • The mean age at first episode of CSA was 10 years, and most (71%) of the women were aged under 12 years at the time. • Perpetrators of the abuse were usually male (98%) and usually known to the child; 41% were relatives. • The mean age of abusers was 34 years, with a median age difference of 24 years from that of the abused individual. • Only 10% of CSA experiences were ever reported to the police, a doctor or a helping agency (e.g., community organisations, such as sexual assault services). Conclusion The high rates of CSA (estimated to be 20% of all women) and low rates of reporting (10%) indicate the need for general practitioners and other health professionals to be aware that a history of such abuse may be common in women in the general population.

Meta-Analytic Procedures for Social Research.

Article

Jan 1994

The Prevalence of Child Abuse and Neglect: A Study of Young People

Article

May 2001
INT J MARKET RES

Describes a survey among young people about experience of abuse or neglect, conducted by BBMRB Social Research for the NSPCC in connection with their Full Stop campaign. It was known that crimes against children tend to be underreported. A key objective was to provide robust and reliable benchmarks for the measurement of child abuse and neglect and public attitudes to them. Research challenges which had to be resolved were: how abuse should be defined; context, approach and presentation of the study; how to maximise response rate and minimise/account for bias; data collection method; size, type and composition of the sample (a crucial issue, discussed in some detail); questionnaire design; memory and recall; interviewer briefing and fieldwork issues; confidentiality and ethics. The very sensitive questionnaires had to be well piloted. CAPI was essential because of the complexity of potential interviews. Key results are summarised (a full report is available: ‘Child Maltreatment in the United Kingdom’, Cawson, Wattam, Brooker and Kelly, 2000), under the following heads: physical abuse, physical neglect, emotional or psychological maltreatment, sexual abuse. The results have suggested that the present child protection system in the UK is inadequate in several respects, and raises important questions for public policy, and for the need for continuing research in this area.

Health Risk Behaviors and Attempted Suicide in Adolescents Who Report Prior Maltreatment

Article

Jun 1992
J HEALTH CARE POOR U

We hypothesized that high school students who experienced prior maltreatment would be more likely than their peers to report health risk behaviors and suicide attempts. Before the establishment of an urban public high school-based clinic, an anonymous needs assessment survey was completed by 600 adolescents (grades 9-12). Sociodemographic information was obtained and questions were asked about physical and sexual abuse, health-related behaviors and habits, and suicide attempts. The mean age of the students was 15.8 years; 52 percent were girls; 23 percent were from families on welfare; and 56 percent from single-parent families or other living arrangements (e.g., with grandparents). Thirteen percent of the adolescents had been maltreated: 5.2 percent reported prior physical abuse, 5.4 percent sexual abuse, and 2.7 both physical and sexual abuse. Multivariate statistical techniques were used to clarify how previous abuse was related to adolescent risk-taking behaviors and suicide. Students with a history of physical abuse were 3.3 times more likely (CI95% : 1.2-9.6; p≤0.01) than nonabused peers to drink alcohol and smoke cigarettes, almost twice as likely (CI95% : 1.0-5.1; p=0.05) to use illicit drugs, 5.8 times more likely (CI95% : 1.3-26.1; p : 1.8-15.4; p≤0.01) to attempt suicide. A student with a history of prior sexual abuse had a 3.5 times greater chance of being sexually active and was more than three times more likely to attempt suicide. These data on a nonclinical, nondeviant population of adolescents indicated that physical or sexual abuse in childhood may have a significant impact on adolescent health risk behaviors and suicide attempts.

A Global Perspective on Child Sexual Abuse: Meta-Analysis of Prevalence Around the World

Abstract and Figures

Recommended publications

Undergraduate Students' Attributions of Depicted Adult–Adolescent and Adolescent–Adolescent Sexual I...

The Effects of Child Sexual Abuse: Comment on Rind, Tromovitch, and Bauserman (1998)

Unsolicited reports of sexual abuse in a comparative study of treatments for bulimia

Why children tell: A model of children's disclosure of sexual abuse