Up to one-quarter of people who suffer child sexual abuse might be passed over for treatment because of current screening procedures, according to UC Riverside psychology researchers, who also found that whether survivors of child sexual abuse identify themselves as abuse survivors influences the outcomes they experience in young adulthood.

Research has previously shown sexual abuse survivors suffer from increased mental health problems, a poor view of themselves, and are more likely to engage in risk-taking behaviors. The new UCR research looks at the impact of the survivor’s perception of the abuse.

Sexual abuse is difficult to define and study. In this study, researchers defined sexual abuse as sexual contact between a minor and a person five or more years older. The study considered how age of onset of abuse, identity of the perpetrator, and degree of force influenced survivor’s later psychosocial outcomes and whether the survivor self-defined their experiences as sexual abuse..

The study surveyed 2,195 undergraduate college students, about two-thirds of whom were female. The sample was almost half Asian, about one-fourth Latino; 17% white; 7% Black; and 4% multiracial/other.

Survey questions sought to determine which participants had suffered abuse with questions such as: “Before the age of 17, were you ever touched in a sexual way that made you feel uncomfortable, when you did not want to be, or at a time when you couldn’t defend yourself?” and more specific follow-up questions about penetration, force, and identity of the perpetrator. Participants who reported experiences of child abuse survivors were then asked: “To the best of your knowledge, before the age of 17, were you sexually abused?” to identify survivors who self-defined their experiences as sexual abuse and those who did not.

The study found 252, or 11%, of those in the study reported experiences of child sexual abuse–similar to percentages researchers have found in the broader population.

Of those 252, 193, or about 77%, identified as sexual abuse survivors, but 59, about 23%, did not self-identify as sexual abuse survivors. Of the remaining group, 1,202 reported no maltreatment, and 741 were excluded because they reported other forms of childhood maltreatment, such as physical abuse or neglect.

“Child sexual abuse survivors who do not acknowledge their experiences as abuse may be employing a protective mechanism wherein the survivor denies the existence of the abuse or takes personal responsibility for the abuse,” said Linnea Linde-Krieger, lead author of the paper, which was published this month in the Journal of Child Sexual Abuse.

The results indicated that as child abuse survivors moved into young adulthood, the form and extent of their difficulties were influenced by how they defined their abuse experiences–even though the way they defined those experiences was not related to the severity of the abuse they experienced.

Neither form of identity was more advantageous, the researchers found. When participants identified as abuse survivors, they were more likely to exhibit distress and anger, and had more difficulty regulating their emotions. That group was also more likely to engage in substance abuse, criminal activity, and sexual risk-taking. However, participants who reported experiences of sexual abuse but didn’t identify as abuse survivors were more likely to have a poor self-concept.

“Our study shows that survivors who do not acknowledge their experiences as abuse might be protected from some negative outcomes, but they are more likely to have negative beliefs about themselves,” said Linde-Krieger, who is a graduate student in the lab of UCR psychology professor Tuppett Yates.

An additional finding: the study authors determined that children abused after the age of 6 were more likely to report that they did not believe they were sexually abused. Researchers said that may be because children are more likely to blame themselves when the age of onset is older.

Linde-Krieger said the research holds implications for organizations and government agencies that assess for adverse experiences in childhood, including for sexual abuse. Often, their questionnaires ask only a single question, such as: “Have you ever been sexually abused?” One-quarter of the survey’s abuse survivors would have answered “no” to such a question, Linde-Krieger said.

“Researchers and practitioners must employ multifaceted and behaviorally specific questions to accurately assess a history of child sexual abuse,” she said.

In addition to Linde-Krieger and Yates, educator Cynthia Moon, who completed her Master of Arts at UCR, contributed to the research paper, “The Implications of Self-Definitions of Child Sexual Abuse for Understanding Socioemotional Adaptation in Young Adulthood.”

Mother Leony – in his 80s; and is one of the regulars of Home for the Golden Gays (HGG) – loves sharing about his sexual experiences. “Sa edad kong ito (At my age),” he says, somewhat jokingly, “malakas pa rin benta ko (I can still attract).”

Mother Leony, of course, belies the ill-conceived notion that members of the mature-aged population become asexual or at least have inactive sexual lives. But exactly because of the still-held stereotype that mature-aged people do not want to or are unable to have active, satisfying sex lives, people like him are among those not getting sexual health services.

This has been studied before; but it is now emphasized by yet another study undertaken by the University of Chichester, alongside organizations in the UK, Belgium and Netherlands. This study revealed negative attitudes and limited knowledge towards over-45’s sexual health needs, which is therereby associated with a generation unaware of the dangers of unprotected intercourse.

Stressing that over-45s are at a higher risk of contracting STIs than ever before because of society’s unwillingness to talk about middle-aged and older people having sex, the report also found that over-45s living in socially and economically-disadvantaged areas are at particularly risk of contracting STIs with little awareness of available healthcare services and limited access to doctors and nurses.

University of Chichester senior lecturer Dr. Ian Tyndall, who led the study, said that major changes in sexual behavior in recent decades has seen increasing numbers of sexually active older-people.

“Over-45s at most risk are generally those entering new relationships after a period of monogamy, often post-menopause, when pregnancy is no longer a consideration, but give little thought to STIs,” he said. “Given improvements in life expectancy, sexual healthcare needs to improve its intervention for older adults and vulnerable groups to provide a more utilized, knowledgeable, compassionate, and effective service.”

In the UK, there is a three-year SHIFT study, which was launched in 2019 to address the growing rates of STIs in over-45s and improve engagement of older people in sexual health services, including those facing socioeconomic disadvantage.

The latest SHIFT report included around 800 participants across the south coast of England and northern regions of Belgium and the Netherlands, nearly 200 of which face socioeconomic disadvantage.

Initial findings highlighted four critical areas where, the researchers believe, an intervention can address the gaps in current healthcare provision: awareness, access, knowledge, and stigma.

• Awareness: The results showed that a significant number of participants were unaware of the risks of STI, while 46% did not know the location of their nearest healthcare center. Researchers did, however, find that social media was the most effective tool for encouraging engagement with sexual health services – ahead of leaflets or GP appointments.
• Knowledge: The participants highlighted that their health professionals, including doctors and nurses, lacked sufficient sexual health knowledge – and consequently only half had a recent STI test. There is therefore an “urgent need” to create a tailored training program to increase understanding in the wider healthcare workforce, the researchers wrote.
• Stigma: Shame was identified as the biggest barrier to accessing sexual healthcare services, according to the report. A number of participants felt that sexual health has become a “dirty” term which is discouraging people from attending regular check-ups.
• Access: Limited information around the location of sexual health centers and restricted opening times were a consistent problem for many participants. Others living in more rural locations also mentioned that growing costs of public transport was a barrier to appointments.

Fellow SHIFT researcher Dr Ruth Lowry said: “It is clear from the numbers reporting fear of being judged by important others who know them and by health professionals that stigma remains a crucial barrier to address in any sexual health promotion intervention.”

Lowry also said that “the findings have also shown that groups with one or more socio-economic disadvantages, such as homeless people, sex workers, non-native language speakers and migrants, are at even greater risk of being unaware of their sexual health and unable to access the appropriate services.”

In the Philippines, an earlier study by Michael David Tan, John Ryan Mendoza and Raine Cortes (2012) – with the study also involving Mother Leony – highlighted that this is also an issue here.

At least for Tan, Mendoza and Cortes, recommendations include: broadening of existing HIV and AIDS programs for prevention and sexual health education to also target the mature-aged gay men population because they are also at risk given that they also practice MSM behavior; the need to inform government policy makers of the specific needs of mature-aged gay men, since existing laws “fail to consider the variations of the experiences of the sub-populations within the generalized mature-aged population”; and the need to “indiginize” the solutions provided to this population.

Loneliness is a prevalent and serious public health problem impacting health, well-being and longevity. Seeking to develop effective interventions, researchers at University of California San Diego School of Medicine examined the psychological and environmental factors that lead to patterns of loneliness in different age groups.

Researchers used a web-based survey of 2,843 participants, ages 20 to 69 years, from across the United States.

The study, published in the November edition of the Journal of Clinical Psychiatry, found that levels of loneliness were highest in the 20s and lowest in the 60s, with another peak in the mid-40s.

“What we found was a range of predictors of loneliness across the lifespan,” said corresponding senior author Dilip V. Jeste, MD, senior associate dean for Healthy Aging and Distinguished Professor of Psychiatry and Neurosciences at UC San Diego School of Medicine.

The researchers noted that lower levels of empathy and compassion, smaller social networks, not having a spouse or a partner and greater sleep disturbances were consistent predictors of loneliness across all decades. Lower social self-efficacy — or the ability to reflect confidence in exerting control over one’s own motivation, behavior and social environment — and higher anxiety were associated with worse loneliness in all age decades, except the 60s.

Loneliness was also associated with a lower level of decisiveness in the 50s.

The study confirmed previous reports of a strong inverse association between loneliness and wisdom, especially the pro-social behaviors component (empathy and compassion).

“Compassion seems to reduce the level of loneliness at all ages, probably by enabling individuals to accurately perceive and interpret others’ emotions along with helpful behavior toward others, and thereby increasing their own social self-efficacy and social networks,” said Jeste.

The survey suggested that people in their 20s were dealing with high stress and pressure while trying to establish a career and find a life partner.

“A lot of people in this decade are also constantly comparing themselves on social media and are concerned about how many likes and followers they have,” said Tanya Nguyen, PhD, first author of the study and assistant clinical professor in the Department of Psychiatry at UC San Diego School of Medicine. “The lower level of self-efficacy may lead to greater loneliness.”

People in their 40s start to experience physical challenges and health issues, such as high blood pressure and diabetes.

“Individuals may start to lose loved ones close to them and their children are growing up and are becoming more independent. This greatly impacts self-purpose and may cause a shift in self-identify, resulting in increased loneliness,” said Nguyen.

Jeste said the findings are especially relevant during the COVID-19 global pandemic.

“We want to understand what strategies may be effective in reducing loneliness during this challenging time,” said Jeste. “Loneliness is worsened by the physical distancing that is necessary to stop the spread of the pandemic.”

Nguyen said intervention and prevention efforts should consider stage-of-life issues. “There is a need for a personalized and nuanced prioritizing of prevention targets in different groups of people,” said Jeste.

Co-authors include: Ellen Lee, Rebecca Daly, Tsung-Chin Wu, Yi Tang, Xin Tu, Ryan Van Patten, and Barton Palmer, all at UC San Diego.

Women who experience sexual violence combined with other forms of intimate partner violence suffer greater damage to their health and are much more likely to attempt suicide, according to a study led by researchers at the University of Bristol’s Centre for Academic Primary Care published in the International Journal of Epidemiology .

Intimate partner violence – psychological, physical or sexual violence perpetrated by a current or former partner – is the most common form of violence experienced by women worldwide.

The study (titled ‘Categories and health impacts of intimate partner violence in the World Health Organization (WHO) multi-country study on women’s health and domestic violence’), conducted in collaboration with the World Health Organization (WHO) and University of Melbourne, found that all types of intimate partner violence were associated with long-lasting damage to health but combinations that included sexual violence were more common and markedly more damaging to women’s physical and mental health.

Researchers analyzed data from the WHO multi-country study on women’s health, which has information from 16 different sites in 11 different countries on over 21,000 women who have ever had a partner. This new analysis assessed different combinations of psychological, physical and sexual intimate partner violence and their impacts on health.

They found that over 15% of ever-partnered women had experienced a combination of intimate partner violence that included sexual violence. Those who had experienced this in the last year were ten times more likely to attempt suicide than those who had not.

Women who had experienced multiple forms of abuse were also more likely to experience difficulty walking, difficulty with daily activities, pain or discomfort, poor memory or concentration, dizziness, and vaginal discharge, and to be taking sleeping pills or painkillers.

All types of intimate partner violence were associated with long-lasting damage to health but combinations that included sexual violence were more common and markedly more damaging to women’s physical and mental health.

Study lead, Dr Lucy Potter a GP and NIHR In-Practice Clinical Research Fellow at the University of Bristol’s Centre for Academic Primary Care, said: “We know intimate partner violence is damaging to health. What this study adds is the recognition of the profound harm caused by multiple forms of abuse, particularly when it includes sexual violence, and how we do not see this when all forms of abuse are lumped together as one experience. Practitioners and policy makers must appreciate the diversity of experience of intimate partner violence to tailor support appropriately.

“We also found that these health impacts persist over a year after the abuse ends. So, effective prevention and early intervention are vital to the health of individuals and families and health systems.”

Senior author, Professor Gene Feder from the University of Bristol’s Centre for Academic Primary Care, said: “Violence against women is a violation of human rights that damages their and their children’s physical and mental health, with substantial health care and societal costs. It is an important cause of ill health among women globally and an indicator for Goal 5 – Gender Equality and Women and Girls’ Empowerment – of the United Nations’ Sustainable Development Goals.

“This study, analyzing the impact of different types and combinations of intimate partner violence, shows the severe health impact when these include sexual or psychological abuse. These types of abuse are often not recognized by health care providers.”

Women who had experienced multiple forms of abuse were also more likely to experience difficulty walking, difficulty with daily activities, pain or discomfort, poor memory or concentration, dizziness, and vaginal discharge, and to be taking sleeping pills or painkillers.

Intimate partner violence is a big issue in the LGBTQIA community.

In 2018, for instance, nearly half of men in same-sex couples suffered some form of abuse at the hands of their partner, according to a study that surveyed 320 men (160 male couples) in Atlanta, Boston and Chicago in the US to measure emotional abuse, controlling behaviors, monitoring of partners, and HIV-related abuse.

Unfortunately, a 2019 study found that domestic and family violence (DFV) and intimate partner violence (IPV) were perceived by community members and professional stakeholders to be a “heterosexual issue that did not easily apply to LGBTQIA relationships.” In particular, many community members held the view that relationships between (LGBTQIA) people could avoid the inherent sexism and patriarchal values of heterosexual, cisgender relationships, and, by implication, avoid DFV/IPV.

LGBTQIA people are almost four times more likely than non-LGBTQIA people to experience violent victimization, which includes rape, sexual assault, and aggravated or simple assault.

This is according to a study by the Williams Institute at UCLA School of Law, which also found that LGBTQIA people are more likely to experience violence both from someone known to the victim and at the hands of a stranger.

For this study (“Victimization rates and traits of sexual and gender minorities in the United States: Results from the National Crime Victimization Survey, 2017”), the researchers analyzed data from the 2017 National Crime Victimization Survey in the US. Written by Andrew Flores, Lynn Langton, Ilan H. Mayer and Adam P. Romero, the study was published in Science Advances.

The results showed that, in 2017, LGBTQIA people experienced 71.1 victimizations per 1,000 people, compared to 19.2 victimizations per 1,000 people for non-LGBTQIA people.

LGBTQIA people are more likely to experience violence both from someone known to the victim and at the hands of a stranger.

“We found that the odds of violent victimization among sexual and gender minorities (SGMs) were almost four times that of non-SGMs,” the researchers stated, adding that the higher rates were noticeable “across nearly all of the violent crime subtypes”.

In a statement, Flores said that it may be worth asking why this is happening. And for him, a “plausible cause is anti-LGBTQIA prejudice at home, work or school, which would make LGBTQIA people particularly vulnerable to victimization in numerous areas of their everyday life.”

Other findings included:

• LGBTQIA people are about six times more likely to experience violence by someone who is known to them and about 2.5 times more likely to undergo it at the hands of a stranger
• LBTQIA women are five times more likely than non-LBTQIA women to experience violent victimization
• The risk of violence for GBT men is more than twice that of non-GBT men
• About half of all victimizations are not reported to police.

For Meyer, the study’s findings “point to the importance of policies and interventions to reduce victimization and the need to consider the unique susceptibility to violence and the high rates of crime experienced by LGBTQIA people.”

For many years, lesbian, gay, bisexual, and other non-heterosexual (LGB+) folks have been known to be more likely to smoke than their straight counterparts. But a new, first-of-its-kind Boston University School of Public Health (BUSPH) study paints a more precise picture by looking at LGB+ identities separately and over time, finding that bisexuality is the identity most associated with smoking, especially around the time of coming out.

Published in the journal JAMA Pediatrics, the nationally-representative cohort study followed 7,843 youth and young adults over three years, finding that those who came out as bisexual were twice as likely as consistently-heterosexual participants to start smoking. Coming out as lesbian, gay, or another non-heterosexual identity, or having a consistent LG+ identity, was not associated with being more likely to smoke.

Bisexual young people may face unique forms of discrimination and stigma that increase their risk for smoking or other substance use behaviors.

The study “highlights the importance of moving beyond static measures of sexual identity towards more dynamic measures that capture critical periods of vulnerability,” says Dr. Andrew Stokes, assistant professor of global health at BUSPH and the study’s corresponding author.

“This approach turned out to be really important, because it revealed disparities that would have otherwise been missed if we measured identity at one time point, or grouped all LGB+ identities together,” says study lead author Alyssa Harlow, a doctoral candidate at BUSPH.

Bisexual young people may face unique forms of discrimination and stigma that increase their risk for smoking or other substance use behaviors, Harlow adds.

“For example, they may experience stigma from heterosexual individuals as well as from within the LGB+ community. There’s also prior research that shows that bisexual populations have worse mental health outcomes than LG+ populations,” Harlow says.

The findings point to a need for public health interventions specifically designed to address the unique needs, experiences, and stressors associated with coming out and identifying as bisexual.

For the study, the researchers used data from the first four waves of the American Population Assessment of Tobacco and Health (PATH) study, which surveyed the same 14-29-year-olds three times between 2013 and 2018. (There were too few transgender respondents in this sample for the researchers to include gender identity in their analysis.) The researchers adjusted for other variables including sex, age, race/ethnicity, education level (for participants over 18) and parents’ education level (for participants under 18), and where participants lived (urban/nonurban, and region of the U.S.).

By the third wave, 14% of the respondents had smoked at some point, and 6% were current smokers. The researchers found that the same sexual identity patterns held true both for having smoked at any point in the study period and for being a current smoker.

The researchers found that, compared to a consistent heterosexual identity, coming out as bisexual was associated with being more than twice as likely to smoke. Participants with LG+ identities in the first wave who shifted to a bisexual identity, or vice versa, were twice as likely to smoke.

On the other hand, participants with a consistent LG+ identity throughout the three waves of the study and participants who started out identifying as heterosexual and came out as LG+ were not more likely to smoke than those with a consistent heterosexual identity–while those with a consistent bisexual identity were slightly more likely to smoke.

The researchers say that the study’s unique approach to LGB+ identities–separated and over time–could provide valuable insights for other issues that disproportionately affect the community, including mental health issues and substance use.

But to make that possible, more national surveys need to ask youth about their sexual orientation and gender identity, says study co-author Dielle Lundberg, a research fellow at BUSPH.

“The PATH study is unique because it asks youth about their sexual orientation and gender identity. Most national surveys do not,” Lundberg says. “We must advocate for better data. Whenever national surveys fail to ask about sexual orientation and gender identity, they are directly contributing to health inequities for LGBTQ+ populations.”