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Background: An important element of reducing the sexual abuse and exploitation of children is to understand the behaviors of individuals who consume child sexual abuse material (CSAM), including the predictors of continued use., Objective: To investigate predictors of 'ever viewing' CSAM and subsequent intentional use among individuals in the community., Method: This study used multivariate logistic regression analysis to identify significant predictors of ever viewing CSAM (n = 742) in an anonymous survey of 5512 Internet users in the community, and of subsequent intentional CSAM use among a subset of 459 CSAM viewers., Results: The characteristics of respondents that were significantly associated with ever viewing CSAM were being male, older in age (25-34 and 55+ years cf. 18-24 years), residing in Australia, New Zealand, or Canada (cf. the United Kingdom), earlier exposure to adult pornography (<14 years), experiencing childhood physical abuse or neglect, viewing bestiality pornography featuring adults, viewing bondage/S&M (BDSM) pornography featuring adults, being likely (self-reported) to have sexual contact with a child, and visiting pedophilic chat forums online. In the subset sample, almost half (218, 47.5 %) viewed CSAM again intentionally after first exposure. Predictors of subsequent intentional viewing of CSAM after adjusting for age and country of residence were being male, ever experiencing loneliness, searching for CSAM intentionally at first exposure, being likely (self-reported) to have sexual contact with a child, and visiting pedophilic chat forums online., Conclusions: The findings have strong implications for prevention of first exposure to CSAM, and of continued CSAM use after exposure does occur., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aotearoa New Zealand's high rates of intimate partner violence (IPV) and child abuse and neglect point to a clear need to develop and resource equitable mental health and addiction practices that are responsive both to people experiencing and using violence, and to their families. Current responses to IPV in mental health and addiction settings in Aotearoa New Zealand require a critical re-framing, from an individualistic autonomy and empowerment framework that constrains practitioners' practice, to an understanding IPV as a form of social entrapment. Using a composite story constructed from 28 in-depth New Zealand family violence death reviews, we highlight current problematic practice and discuss alternative responses that could create safer lives for people and families. Re-framing IPV as a form of social entrapment acknowledges it as a complex social problem that requires collective steps to secure people's safety and well-being. Importantly, a social entrapment framework encompasses interpersonal and structural forms of violence, such as the historical and intergenerational trauma of colonization and links to ongoing structural inequities for Māori (the indigenous people of Aotearoa) in Aotearoa New Zealand., (©2019 The Authors International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd on behalf of Australian College of Mental Health Nurses Inc.)

Background: We aimed to investigate associations between childhood sexual abuse and maltreatment and internalizing disorders (anxiety, depression, PTSD) across adulthood., Methods: Following a postal survey of 2220 women, a subsample was selected to participate in an interview. The subsample included 276 women reporting childhood sexual abuse and 221 women with no reported history of childhood sexual abuse. Interviews were repeated six and 25 years following the first interview. Internalizing disorders were assessed using ICD-8 and DSM-III criteria., Results: There was a lower probability of having an internalizing disorder at older ages than younger ages for all women, regardless of maltreatment history. Latent class analysis was used to define three classes (no/low maltreatment, sexual abuse, poly-victimisation). Compared with no/low maltreatment, a history of childhood sexual abuse was associated with almost double the risk of an internalizing disorder and a history of poly-victimisation was associated with over four times the risk of an internalizing disorder. Childhood sexual abuse and poly-victimisation remained associated with an elevated risk of a disorder in older age., Limitations: Findings are limited by attrition (39% participated at Time 3), low prevalence of severe physical abuse, and changes in assessment practice of childhood maltreatment and mental disorder in the past 30 years., Conclusions: Screening and treatment for internalizing disorders in women with histories of childhood maltreatment remains important in older aged populations., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: Childhood sexual abuse (CSA) has been associated with many adverse medical, psychological, behavioral and socioeconomic outcomes in adulthood. This study aims to examine the linkages between CSA and a wide range of developmental outcomes over a protracted time period to age 30., Methods: Data from over 900 members of the New Zealand birth cohort the Christchurch Health and Development Study were examined. CSA prior to age 16 was assessed at ages 18 and 21 years, in addition to: mental health, psychological wellbeing, sexual risk-taking behaviors, physical health and socioeconomic outcomes to age 30., Results: After statistical adjustment for confounding by 10 covariates spanning socio-demographic, family functioning and child factors, extent of exposure to CSA was associated with increased rates of (B, SE, p): major depression (0.426, 0.094, <.001); anxiety disorder (0.364, 0.089, <.001); suicidal ideation (0.395, 0.089, <.001); suicide attempt (1.863, 0.403, <.001); alcohol dependence (0.374, 0.118, <.002); and illicit drug dependence (0.425, 0.113, <.001). In addition, at age 30 CSA was associated with higher rates of PTSD symptoms (0.120, 0.051, .017); decreased self-esteem (-0.371, 0.181, .041); and decreased life satisfaction (-0.510, 0.189, .007). Childhood sexual abuse was also associated with decreased age of onset of sexual activity (-0.381, 0.091, <.001), increased number of sexual partners (0.175, 0.035, <.001); increased medical contacts for physical health problems (0.105, 0.023, <.001); and welfare dependence (0.310, 0.099, .002). Effect sizes (Cohen's d) for the significant outcomes from all domains ranged from .14 to .53, while the attributable risks for the mental health outcomes ranged from 5.7% to 16.6%., Conclusions: CSA is a traumatic childhood life event in which the negative consequences increase with increasing severity of abuse. CSA adversely influences a number of adult developmental outcomes that span: mental disorders, psychological wellbeing, sexual risk-taking, physical health and socioeconomic wellbeing. While the individual effect sizes for CSA typically range from small to moderate, it is clear that accumulative adverse effects on adult developmental outcomes are substantial., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The present study explored health professionals' experiences with adult survivors of child sexual abuse in New Zealand. Face-to-face, semistructured interviews of up to an hour took place with 13 health professionals. The participants were asked about training, screening practices, their response to disclosures, and advice to other health professionals. A model-transition to ethical practice-emerged from the data, where delivering more sensitive health care to child sexual abuse survivors sits on a continuum from lack of awareness of child sexual abuse to delivery of care where all patients are comfortable. We recommend making sensitive care for all as the standard care of practice and providing training for health professionals on how to deal with disclosures.

Problems: In order to better understand the long-term impact of child sex abuse, this study examined the association between women's experience of abuse, health symptoms, and psychological distress in adulthood. There is limited information about child abuse outside the United States., Methods: Nine hundred sixty-one women participated in a structured interview., Results: Participants who had experienced abuse (13%) were significantly more vulnerable to psychological distress in adulthood if they were younger, less satisfied with their standard of living, and resided in urban areas., Conclusion: Dissemination and evaluation of therapies for the treatment of sex abuse in the New Zealand context is warranted., (© 2012 Wiley Periodicals, Inc.)

Individuals from some minority cultures are at greater risk of experiencing childhood sexual abuse (CSA) and are also at heightened risk of negative outcomes from abuse. Coping strategies, which may mediate the relationship between CSA and outcomes, are also impacted by culture. This study examined the use of coping strategies in female survivors of CSA across 4 cultural groupings from 2 countries-86 European Canadians, 40 Native Canadians, 129 European New Zealanders, and 35 Māori New Zealanders-who all completed the Coping Responses Inventory. The 4 groups differed significantly on 7 of the 8 Coping Responses Inventory scales (Logical Analysis, Positive Reappraisal, Problem Solving, Cognitive Avoidance, Acceptance or Resignation, Seeking Alternative Rewards, Emotional Discharge). Whereas New Zealanders differed significantly from Canadians (p<.001), Europeans did not differ significantly from indigenous cultural groups, nor did nationality and culture grouping interact (p>.05). The profile of coping in New Zealand Europeans was relatively flat, with average scores across coping types close to the mean of the t-score distribution. Māori New Zealanders produced a similar profile, with only slight increases on 2 scales of avoidant coping. The findings raise questions about the extent to which generalizations can be made about there being either a "Western/European" culture or a particular "indigenous" culture. This in turn also raises the issue of whether cross-validation and replication of findings are needed if the findings are to be applied outside of the country in which the data were gathered.

Eighty-five New Zealand based practitioners experienced in treating adults with a history of child sexual abuse participated in an online judgment study of child sexual abuse outcomes using signal detection theory methodology. Participants' level of sensitivity was assessed independent of their degree of response bias when discriminating (a) known child sexual abuse outcomes from behaviors thought to be unrelated to child sexual abuse and (b) direct child sexual abuse effects from subsequent coping strategies. Results demonstrated good sensitivity (accuracy) when identifying child sexual abuse effects from noneffects. When asked to discriminate direct child sexual abuse effects from ways of coping with distress, practitioners' accuracy was reduced, revealing a tendency to identify all effects as coping. Although treatment approaches highlight the pivotal role of identifying coping strategies, practitioners did not perceive maladaptive coping as a distinct clinical feature. Complex abuse cases may benefit from replacing maladaptive coping strategies (e.g., self-harm) with constructive coping (e.g., social support) in order to deliver efficacious practice.

A qualitative analysis of the accounts of 29 adults who grew up in a controversial New Zealand community identified positive and negative experiences and their psychological implications. In addition to highly publicized child sexual abuse that occurred at Centrepoint, children also experienced parental neglect, psychological manipulation, illegal drug use and stigma from the broader society. These factors created an adverse matrix that facilitated sexual abuse. Positive experiences included support for vulnerable families and children, recreational activities, and the opportunity to develop communication skills. While there may be positive experiences for children living in intentional communities such as this one, it is important to be aware of the potential for psychological harm to children in communities with powerful, shared systems of belief, skepticism about the broader society, and strong dynamics of dependence. These findings may have implications for other similar communities operating elsewhere in the world.

Adult survivors of child sexual abuse are high users of health and mental health services. Health professionals are well placed to improve health outcomes for them by delivering positive interventions post-abuse. The current study explored female child sexual abuse survivors' opinions on how health professionals could work better with child sexual abuse survivors. Sixty-one women, from 22-65 years old, who had been sexually abused before the age of 16 years, completed postal questionnaires in late 2004. A model was developed to guide the development of knowledge, skills, and practices for working more sensitively with child sexual abuse survivors. The model consisted of six chronological training steps: (1) knowledge on effects of child sexual abuse; (2) establishing the relationship with child sexual abuse survivors; (3) asking about child sexual abuse; (4) responding to disclosure; (5) sensitive provision of medical examinations; and (6) follow-up post examination. A systematic approach to training is proposed to assist with improving delivery of services sensitive to child sexual abuse survivor needs.

Out of control sexual behavior, also known as compulsive sexual behavior or sexual addiction, has not been studied in a representative sample of the general population. At age 32 years, 940 (93%) of 1,015 members of the birth cohort of the Dunedin Multidisciplinary Health and Development Study responded to a series of questions about sexual behavior, administered by computer. We enquired about sexual fantasies, urges or behavior that participants regarded as out of control during the previous year, and defined such experiences as out of control sexual experiences (OCSE). Nearly 13% of men and 7% of women reported OCSE in the past year. Women who reported such experiences were more likely than other women to have reported (elsewhere in the interview) having had high numbers of opposite sex partners, concurrent sexual relationships, or sex with a partner met on the internet, as well as a higher likelihood of same-sex attraction or behavior. Among men reporting OCSE, there was an association with having paid for heterosexual sex and with same-sex attraction and behavior. Few believed that OCSE had interfered with their lives (3.8% of all men and 1.7% of all women in the cohort). Only 0.8% of men and 0.6% of women reported that their actual sexual behavior had interfered with their lives. OCSE were also analyzed in relation to certain personality traits and to childhood sexual abuse (CSA). Some evidence of a link with impulsivity (women only) and negative affectivity was found. CSA was associated with OCSE among men. In conclusion, this population-based study has provided the first empirical estimations of the occurrence of OCSE and its relationship to a range of sexual behaviors in a representative sample.

The Violence Risk Scale: Sexual Offender Version (VRS:SO) is a rating scale designed to assess risk among sexual offenders and the degree of change achieved in treatment. The scale consists of 7 static and 17 dynamic risk items, with protocols for measuring treatment change based on the Transtheoretical Change Model. The aim of the current study was to evaluate the psychometric properties of the VRS:SO on an independent sample of 218 child molesters who received treatment at a prison-based program in New Zealand and who were followed up for an average of 12.2 years. Supporting the initial validation of the VRS:SO, the results indicated good interrater reliability, concurrent validity, and predictive validity of the measure--VRS:SO scores were predictive of sexual recidivism (for Dynamic and Total scores, area under the curve value approximately .80), and the dynamic scale made significant incremental contributions after controlling for static risk. The authors also analyzed the validity of the factor structure of the VRS:SO dynamic scale and compared the measure with an alternative measure of dynamic risk based on a self-report psychometric battery.

This study reports on a postal questionnaire, conducted in 2004, with female survivors of historic child sexual abuse. The questionnaire explored their experiences of health professionals' responsiveness to disclosure of child sexual abuse history. Of 61 participants, aged between 22 and 65, 69% had disclosed to health professionals. Those who had not disclosed reported that they would have liked to but were not asked about child sexual abuse. Thirty-five percent of participants suggested routine questioning about child sexual abuse. Most participants related a fear of common medical examination procedures to their experience of child sexual abuse, and 64% said this stopped them from attending regular health checks. The current study suggests the development of guidelines for dealing with possible child sexual abuse survivors would be useful for health professionals.

Objectives: To determine the impact of child sexual abuse (CSA) on adult sexual behaviors and outcomes over three age periods., Methods: A longitudinal study of a birth cohort born in Dunedin, New Zealand in 1972/1973 was used. Information on CSA was sought at age 26, and on sexual behaviors and outcomes at ages 21, 26, and 32. Comparisons were over the whole period from age 18 to 32, then for the three age periods from age 18 to 21, 21 to 26, and 26 to 32, adjusting for measures of family environment., Results: Overall, 465 women and 471 men (91.9% of the surviving cohort) answered questions about CSA. Contact CSA was reported by 30.3% of women and 9.1% of men. For abused women, significantly increased rates were observed for number of sexual partners, unhappy pregnancies, abortion, and sexually transmitted infections from age 18 to 21; with rates approaching those of nonabused over time. Conversely, for abused men rates were not significantly elevated in the youngest age period, but were for number of partners from age 26 to 32 and acquisition of herpes simplex virus type 2 from age 21 to 32., Conclusions: Gender and age are critical when considering the effect of CSA. While the profound early impact of CSA demonstrated for women appears to lessen with age, abused men appear to carry increased risks into adulthood., Practice Implications: CSA is common and should be considered when young women present with unwanted conceptions or seek multiple terminations, and when men continue to have high risk sexual behavior into adulthood. Furthermore, if CSA is disclosed, sexual risks in adulthood need to be considered.

Research on the causal factors underlying sex offender recidivism has not considered the success or failure of the reintegration process by which the offender rejoins the community after prison. The authors developed a coding protocol to measure the quality and comprehensiveness of reintegration planning for sex offenders. The protocol was retrospectively applied to groups of recidivists and nonrecidivists who were matched on static risk level and follow-up time. The protocol demonstrated adequate reliability. Compared to nonrecidivists, recidivists had significantly lower scores relating to accommodation, employment, and the Good Lives Model secondary goods, as well as lower total reintegration plan scores. ANCOVAs showed that when IQ and level of sexual deviance were controlled for, accommodation (a place to live) was significantly related to sexual recidivism and the Good Lives Model-secondary goods was significantly related to any recidivism. These results suggest that poor reintegration planning may be a risk factor for recidivism.

Objective: This research examined linkages between exposure to childhood sexual abuse (CSA) and childhood physical punishment/abuse (CPA) and mental health issues in early adulthood., Method: The investigation analyzed data from a birth cohort of over 1,000 New Zealand young adults studied to the age of 25., Results: Exposure to CSA and CPA was associated with increased risks of later mental disorders including depression, anxiety disorder, conduct/anti-social personality disorder, substance dependence, suicidal ideation, and suicide attempts at ages 16-25. Control for social, family, and individual factors reduced the associations between CPA and mental health outcomes to the point of statistical non-significance. However, there was a consistent finding for CSA to remain associated with increased risks of later mental health problems. After adjustment, those exposed to CSA including attempted or completed sexual penetration had rates of disorder that were 2.4 times higher than those not exposed to CSA. Those exposed to harsh or abusive physical punishment had rates of disorder that were 1.5 times higher than those exposed to no or occasional physical punishment. It was estimated that exposure to CSA accounted for approximately 13% of the mental health problems experienced by the cohort. Findings showed that exposure to CPA had only weak effects on later mental health. It was estimated that exposure to CPA accounted for approximately 5% of the mental health problems experienced by the cohort., Conclusions: Exposure to CSA was associated with consistent increases in risks of later mental health problems. Exposure to CPA had weaker and less consistent effects on later mental health. These findings suggest that much of the association between CPA and later mental health reflects the general family context in which CPA occurs, whereas this is less the case for CSA.

To explore the relationship between dynamic risk factors and recidivism in child molesters, we studied a sample of men (N=495) who completed an intensive, prison-based treatment program in New Zealand. During the follow-up period (M=5.8 years), 9.9% were reconvicted for a sexual offense. A self-report psychometric battery was administered at pre-treatment that assessed a range of variables related to sexual attitudes and beliefs, emotional functioning, and interpersonal competency. Factor analysis showed that individual differences in the battery could be described by four dimensions-Social Inadequacy, Sexual Interests, Anger/Hostility, and Pro-Offending Attitudes. Factor scores for each dimension were significantly correlated with sexual recidivism. Logistic regression analyses confirmed that the Sexual Interests and Pro-Offending Attitudes factor scores, as well as an Overall Deviance score which combined the dimensions, provided significant additional validity for predicting recidivism beyond the Static-99 (Hanson and Thornton Law and Human Behavior 24:119-136, 2000). When added to the Static-99, the Overall Deviance score increased the area under the Receiver-Operating Characteristic curve (AUC) from 0.72 to 0.81. These results show that psychometric self-reports can provide valid measures of dynamic risk factors, and that inclusion of such measures can improve risk prediction beyond that achievable by static factors alone.

Questionnaires are relied upon by forensic psychologists, clinicians, researchers, and social services to assess child molesters' (CMs') offense-supportive beliefs (or cognitive distortions). In this study, we used an experimental procedure to evaluate whether extrafamilial CMs underreported their questionnaire-assessed beliefs. At time one, 41 CMs were questionnaire-assessed under standard conditions (i.e., they were free to impression manage). At time two, CMs were questionnaire-assessed again; 18 were randomly attached to a convincing fake lie detector (a bogus pipeline), the others were free to impression manage. The results showed that bogus pipeline CMs significantly increased cognitive distortion endorsements compared to their own previous endorsements, and their control counterparts' endorsements. The findings are the first experimental evidence showing that CMs consciously depress their scores on transparent questionnaires.

Professionals conclude that child molesters (CMs) hold offense-supportive beliefs (or cognitive distortions) from CMs'questionnaire responses. Because questionnaires are easily faked, we asked 32 CMs to complete a cognitive distortion scale under standard conditions (Time 1). A week later (Time 2), the same CMs completed the scale again. This time, approximately one half of CMs were attached to a pseudo lie detector (a bogus pipeline), and the rest completed the scale again under standard conditions (controls). At Time 1, CMs showed low cognitive distortion scores, seeming to indicate that they were faking good. At Time 2, bogus pipeline CMs seemed to believe that the apparatus could detect lies. However, this did not encourage more distorted belief disclosure compared with (a) their own previous scores and (b) controls. Furthermore, the bogus pipeline appeared to reduce cognitive distortion endorsements. The results stand in marked contrast to the common view that most CMs hold distorted beliefs.

It is widely observed that child sexual offenders typically exhibit considerable reluctance to self-disclose at a level that reflects the full reality of their offending. Their successful engagement in relapse prevention-based programs is therefore problematic. This paper describes a study involving men undertaking a prototypical group treatment program, facing the challenge of revealing to others the details of their offense process. A procedure was developed to access their covert responses at the time of this encounter. From a grounded theory analysis, participants were found to employ various strategies to manage situations where self-disclosure was required. Four distinct disclosure management styles emerged: exploratory, oppositional, evasive, and placatory; the latter three of which appear unfavorable to effective engagement in treatment. As well as suggesting ways of influencing disclosure management style, analysis indicated that it might be possible to predict these different orientations during routine assessment.

Background: It is well documented that females have higher rates of internalizing disorders (anxiety, depression) than males. It is also well known that females have higher exposure to childhood sexual abuse and sexual assault. Recently, it has been proposed that the higher levels of internalizing disorders in females may be caused by their greater exposure to sexual violence., Method: Data were gathered as part of the Christchurch Health and Development Study. In this study a cohort of 1265 children born in Christchurch, New Zealand, in 1977 have been studied from birth to age 21 years. The measures collected included: major depression and anxiety, childhood sexual abuse and adolescent sexual assault., Results: Findings confirmed the established conclusion that internalizing disorders are over twice as common in females than males (ORs 2.2-2.7). In addition, it was found that females were exposed to higher rates of sexual violence than males (ORs 5.1-8.4). Statistical control for gender related differences in exposure to sexual violence reduced the associations between gender and anxiety and depression. Nonetheless, even after such control, gender was significantly (P < 0.0001) related to both anxiety (OR = 1.8; 95% CI, 1.3-2.4) and depression (OR = 1.9; 95% CI, 1.4-2.3)., Conclusions: Greater female exposure to sexual violence may be a factor that contributes to greater female susceptibility to internalizing disorders. However, even after adjustment for gender differences in exposure to sexual violence it is clear that a substantial relationship between gender and internalizing disorder persists.

Objective: This community-based study examined how some women who have experienced childhood sexual abuse (CSA) develop an eating disorder (ED), whereas others develop depression and anxiety, and others show no adverse psychological sequelae., Methods: A two-stage random community sampling strategy was used to select two groups of women: (1) women with CSA prior to age 16 years and (2) a comparison group of women reporting no abuse. Both groups completed the Parental Bonding Instrument (PBI), the Present State Examination, and additional ICD-10 eating disorders questions. Information on the nature and frequency of the CSA was obtained at interview. CSA women with ED (CSA+ED) were compared with CSA women without ED (CSA-noED) and with CSA women with anxiety and/or depression (psychiatric comparison group)., Results: Higher rates of EDs in women who have experienced CSA were confirmed in this study. Belonging to a younger age cohort, experiencing menarche at an early age, and high paternal overcontrol on the PBI independently increased the risk of developing an ED in women who had experienced CSA. Low maternal care was specifically associated with the development of anorexia nervosa, whereas early age of menarche differentiated women with bulimia nervosa. Younger age and early age of menarche also differentiated the CSA+ED women from the psychiatric comparison group., Discussion: Early maturation and paternal overcontrol emerged as risk factors for ED development in women with CSA. Although these variables are also risk factors in the general population, women with CSA may be vulnerable to ED development because these risk factors are particular domains of concern that emanate from experiences of CSA., (Copyright 2001 by John Wiley & Sons, Inc.)

Among a birth cohort of New Zealand's 21-year-olds, 41% experienced physical or sexual assault in the previous 12 months. The level of psychological distress experienced by the 374 victims was determined in interviews assessing for symptoms indicative of posttraumatic stress disorder and ratings of impairment in activities of daily living. Of the 141 women victims, 32.6% were identified as experiencing psychological distress as were 9.9% of the 233 men. For men, bivariate analyses showed psychological distress was significantly associated with factors indicative of increased assault severity, and for women an increased likelihood of distress was associated with the location of assault and the relationship to the assailant. Positive indicators of social support were not significantly associated with less adverse psychological outcomes. However, for both men and women, resisting the assailant was associated with a reduced likelihood of psychological distress. Multivariate analyses revealed that for both women and men, unemployment uniquely predicted variance in distress, over and above that accounted for by characteristics of the assault.

Because there are few controlled studies, we aimed to determine the prevalence of sexual and physical abuse reported by psychiatric outpatients compared with matched controls. The sample consisted of 158 outpatients with major mental disorders including schizophrenia and bipolar disorder who responded to a semi-structured interview (response rate = 64.8%) and who were individually matched for gender, age, and ethnicity with 158 outpatients who had never been treated for psychiatric illness. They answered questions about whether and when they had ever been sexually or physically abused, and about the type and circumstances of abuse. Abuse was more common during adulthood (16 years or older); 45 psychiatric patients (28.5%) were sexually abused and 43 (27.3%) were physically abused. Compared with the controls, patients were significantly more likely to report a history of sexual or physical abuse during adulthood (chi2 = 5.15, df = 1, p = .02; chi2 = 4.09, df = 1, p = .04 respectively). During adulthood, female patients were significantly more likely to be sexually and physically abused than male patients, and those sexually abused were significantly more likely to report a history of sexual abuse during childhood. However, patients were not significantly more likely to report a history of sexual or physical abuse during childhood compared with the controls. These findings demonstrate that psychiatrically ill patients are vulnerable to sexual and physical abuse during adulthood and underscore psychiatrists' responsibility to routinely inquire about abuse experiences.

Objectives: To describe the mental health of lesbians in New Zealand, and to document their accounts of their experience of mental health services., Method: This is a descriptive cross-sectional study. A postal questionnaire, the Lesbian Mental Health Survey, was distributed via lesbian newsletters to 1222 women throughout New Zealand. Mental health measures included the General Health Questionnaire (GHQ-28), Interview Schedule for Social Interaction (ISSI), and respondents' histories of sexual abuse and psychiatric histories. Experiences of mental health services were sought., Results: The estimated response rate was 50.8%. The respondent group were predominantly New Zealand European, highly educated, urban women between 25 and 50 years of age. Three-quarters had identified as lesbian for more than 5 years. Recent self-identification as lesbian was associated with higher GHQ score, as was being younger than 35, having a history of sexual abuse, and not living with a partner. Eighty percent of respondents had used mental health services sometime in their lives and nearly 30 percent of users had received 'lesbian-unfriendly' treatment at some point. One-sixth of respondents had experienced discrimination from service providers in the previous 5 years., Conclusion: While the mental health of lesbians is influenced by factors similar to those influencing women's mental health in general, because of social factors, such as stigma and isolation, lesbians may be more vulnerable to common mental illnesses. Health professionals, mental health professionals in particular, need to raise their awareness of the issues lesbians face in dealing with their sexuality, therapeutic relationships and mental health services. Increased training about sexuality for health professionals, as well as further research into areas such as stress and stigma, sexual abuse and attempted suicide among lesbian women, is recommended.

Objective: The relationship between three positive symptoms of schizophrenia-hallucinations, delusions and thought disorder-and childhood physical and sexual abuse among psychiatric inpatients was investigated., Methods: From the records of 100 consecutive admissions to an acute psychiatric inpatient unit in a New Zealand general hospital, the records of the 22 patients in which a history of either physical or sexual childhood abuse was mentioned were examined for data on the frequency and content of hallucinations, delusions, and thought disorder., Results: Seventeen of the 22 patients exhibited one or more of the three symptoms. Half of the symptoms for which content was recorded appeared to be related to the abuse. An analysis of the relationships between types of abuse and specific symptoms suggested that hallucinations may be more common than delusions or thought disorder among patients who have been sexually abused, particularly among those who have experienced incest, and that delusions may be more related to having been physically abused., Conclusions: The study findings confirmed previous findings of a high frequency of auditory hallucinations, particularly command hallucinations to kill oneself, and paranoid ideation among inpatients with a history of abuse. The hypothesis that the hallucinations of abuse survivors are "pseudohallucinations" was not supported.

Objective: The psychological defense styles of women who reported childhood sexual abuse were assessed and compared to those of women without childhood sexual abuse., Method: Subjects in a random community sample (N = 354) of New Zealand women were interviewed and completed two relevant questionnaires, the Defense Style Questionnaire and the Dissociative Experiences Scale., Results: Women reporting childhood sexual abuse showed more immature defense styles, and those who experienced the most severe childhood sexual abuse showed the most immature styles. Dissociation, however, as measured on the Dissociative Experiences Scale, was not linked to childhood sexual abuse., Conclusions: Reporting childhood sexual abuse was associated with more immature coping styles, although not dissociation, in this community sample of women. Coping styles are likely to be a major mechanism through which childhood sexual abuse increases rates of later psychological problems.

Aim: To survey New Zealand families where an alleged perpetrator and/or other family member denies an accusation involving the childhood molestation of one family member by another, based on a memory recovered in adulthood. As the validity of such memories is crucial, our aim was to develop a profile of such families and to compare it with New Zealand epidemiological data., Method: Information was collected by questionnaire regarding family demographics, characteristics of the accuser, family life, events surrounding and leading up to the accusations, consequences of the accusations and details of the accuser's current life situation. The 73 subjects included fathers, mothers, siblings and other relatives of the accusing adults., Results: Most accusers were highly educated white women, frequently first born or older children from relatively large families, statistically different proportions from those expected. Many accusations involved events of low base-rate probability including satanic ritual abuse. Proportions differed from those of another New Zealand prevalence survey of 1019 18-year-olds in almost every way., Conclusion: The data suggest that it is unlikely that many, if not most, of the memories of child sexual abuse recovered in adulthood are a true reflection of history. Memories recovered during therapy should be treated with respect as part of the patient's narrative truth, but not assumed to be factually accurate without corroborative evidence.

Objective: To study the relationships between retrospective reports of exposure to interparental violence in childhood and rates of psychosocial adjustment problems in young adulthood in a birth cohort of New Zealand subjects., Method: Data were gathered during the course of an 18 year longitudinal study of a birth cohort of 1,265 New Zealand children. At age 18 retrospective reports of exposure to interparental violence were obtained. At this time the cohort was also assessed on measures of psychosocial adjustment including mental health problems, substance abuse behaviors, and criminal offending., Results: Young people reporting high levels of exposure to interparental violence had elevated rates of adjustment problems at age 18. These problems included mental health problems, substance abuse behaviors and criminal offending. Analyses using multiple logistic regression showed that much of this elevated risk was explained by social and contextual factors associated with exposure to interparental violence. However, even after adjustment for confounding factors, exposure to father initiated violence was associated with increased risks of anxiety, conduct disorder and property crime, while exposure to mother initiated violence was associated only with increased risks of later alcohol abuse/dependence., Conclusion: Children exposed to high levels of interparental violence are an at risk population for psychosocial adjustment problems in young adulthood. Much of the elevated risk of these children arises from the social context within which interparental violence occurs. Nonetheless, exposure to interparental violence, and particularly father initiated violence, may be associated with later increased risks of anxiety, conduct disorder, problems with alcohol, and criminal offending.

Aim: To investigate how often women reporting child sexual abuse obtain professional help for emotional reasons compared with non-abused women and how useful they find it., Method: In a follow-up survey of a random community sample of women, information on formal help for emotional problems was analysed by demographic, health status and abuse information., Results: In the year prior to survey, 11.8% of women in this community sample sought professional help for emotional problems. Women in the child sexual abuse sub-sample were significantly more likely than the comparison sub-sample to have sought help (16.6% vs 7.3%) but marital status (separation) was a more significant predictor. Problematic relationships or depression were the reasons given most often for help-seeking. Therapists/counsellors and general practitioners were the health professionals most often approached. Most help-seekers thought the help useful but some child sexual abuse help-seekers did not. The child sexual abuse sub-sample were more likely to report cost as a barrier., Conclusions: Relationship difficulties and depression are the most common reasons for seeking professional help for emotional problems. Women giving a history of child sexual abuse have higher rates of formal help-seeking and are more likely than other women to report that help they receive is not useful.

Objective: In the context of numerous studies demonstrating that a significant proportion of psychiatric inpatients have been sexually or physically abused at some point in their lives this study ascertained the responses of staff in a psychiatric inpatient unit to knowledge that patients had been subjected to sexual or physical abuse, in childhood or adulthood., Method: The medical records of 100 consecutive admissions were examined. Staff response was measured in terms of: (i) acquiring information about previous treatment for, or disclosure of, abuse; (ii) providing information, support or counselling during hospitalisation; (iii) reporting to legal authorities; and (iv) referring for ongoing abuse counselling., Results: Of the 32 patients who were documented as having disclosed abuse 11 files included documentation of previous treatment or disclosure; none were reported to have received support, counselling or information while in hospital; and three referrals were made for ongoing counselling. None of the 52 separate instances of abuse were reported to the authorities. Demographic, diagnostic, clinical and treatment variables, as well as the four abuse categories, were analysed for possible linkage to probability of staff response in each of the four response categories., Conclusions: It was hypothesised that the low staff response rate is not unique to the particular unit evaluated here. Recommendations are offered regarding the need for unit policies ensuring routine abuse inquiry and for staff training about how to respond to abuse disclosures.

Objective: The literature suggests that a high prevalence of a history of sexual and physical abuse among psychiatric inpatients is found when researchers inquire about abuse directly, but that relatively low rates are found in medical records. This study examined rates of reported abuse among patients who were and were not asked about abuse at admission., Methods: The medical records of 100 consecutive admissions to an urban general hospital in New Zealand were examined after the introduction of a new admission form with a section inquiring about abuse. Use of the new admission form was recommended but not mandatory., Results: The abuse section of the new form was completed for only 17 of the 53 patients with whom the new form was used. Review of the medical records of all 100 consecutive admissions revealed a prevalence rate of 32 percent for one or more of the four types of abuse. However, 14 of the 17 patients (82 percent) who were asked directly about abuse reported having experienced abuse. Nonsignificant trends suggested that male gender and being more disturbed or disturbing may be negatively related to the probability of being asked about abuse. Men may be particularly unlikely to disclose childhood abuse if not asked directly., Conclusions: The authors recommend including inquiry about abuse in standardized admission procedures and providing inpatient staff with training in how and when to ask patients about abuse and how to effectively follow up affirmative responses.

Objective: The aims of this study were to examine the extent to which exposure to childhood sexual abuse (CSA) was associated with increased rates of sexual risk taking behaviors and sexual revictimization during adolescence., Method: A birth cohort of 520 New Zealand born young women was studied at regular intervals from birth to the age of 18. At age 18 retrospective reports of CSA were obtained from sample members. Over the course of the 18 year study information was gathered on: (a) childhood, family, and related circumstances; and (b) the young women's history of sexual experiences from 14 to 18 years., Results: Young women reporting CSA, and particularly severe CSA involving intercourse, had significantly higher rates of early onset consensual sexual activity, teenage pregnancy, multiple sexual partners, unprotected intercourse, sexually transmitted disease, and sexual assault after the age of 16. Logistic regression analyses suggested that the associations between CSA and sexual outcomes in adolescence arose by two routes. First, exposure to CSA was associated with a series of childhood and family factors including social disadvantage, family instability, impaired parent child relationships, and parental adjustment difficulties that were also associated with increased sexual vulnerability in adolescence. Second, there appeared to be a causal chain relationship between CSA and sexual experiences in which CSA was associated with early onset sexual activity which, in turn, led to heightened risks of other adverse outcomes in adolescence., Conclusions: The findings of this study suggest that those exposed to CSA have greater sexual vulnerability during adolescence. This appears to arise because: (a) the childhood and family factors that are associated with CSA are also associated with increased sexual risks during adolescence; and (b) exposure to CSA may encourage early onset sexual activity which places those exposed to CSA at greater sexual risk over the period of adolescence.

The author advances a taxonomy of expert evidence in relation to the responses of sexually abused children to their assaults. He analyses a series of Australian and New Zealand cases in the context of Summit's publicly stated recent views on the use to which Child Sexual Abuse Accommodation Syndrome ("CSAAS") can be put. He argues that expert evidence that goes further than dispelling myths or disabusing triers of fact of misperceptions generally held within the community should not be permitted. He contends that CSAAS is an illegitimate description of such information and that such "syndrome evidence" should not be permitted, particularly before juries. He maintains, moreover, that further rigour will be (and should be) required of prosecutors and mental health professionals alike if such counterintuitive evidence is to be admitted. This will entail proof of the existence of community misunderstanding of the phenomenon, establishment that the field of expertise from which child sexual abuse accommodation evidence emanates is sufficient for the purpose, as well as proof of the expert's expertise in the field. However, he argues against abandoning attempts to use counterintuitive evidence merely on the basis of a number of adverse Australasian determinations, whose reasoning is dependent on the quality of the evidence hitherto advanced and the overly limited perceptions of the evidential framework within which such evidence should be evaluated.

Both the theory that traumatic childhood memories can be repressed, and the reliability of the techniques used to retrieve these memories are challenged in this paper. Questions are raised about the robustness of the theory and the literature that purports to provide scientific evidence for it. Evidence to this end is provided by the authors which surveyed New Zealand families in which one member had accused another (or others) of sexual abuse on the basis of recovered memories. It is shown that a number of these allegations involve very low probability events. Since memory repression theory is not currently scientifically substantiated it is argued that care needs to be taken in the mental health, legal and insurance compensation arenas. Memories recalled during therapy may be treated as metaphorical but, in the absence of corroborative evidence, should not be considered factually true. Clinicians who wish to use memory recovery techniques should inform patients of their experimental and controversial nature, point out adverse effects, and obtain consent before proceeding.

Objective: This is the second in a series of articles that describe the prevalence, correlates, and consequences of childhood sexual abuse (CSA) in a birth cohort of more than 1,000 New Zealand children studied to the age of 18 years. This article examines the associations between reports of CSA at age 18 and DSM-IV diagnostic classifications at age 18., Method: A birth cohort of New Zealand children was studied at annual intervals from birth to age 16 years. At age 18 years retrospective reports of CSA prior to age 16 and concurrently measured psychiatric symptoms were obtained., Results: Those reporting CSA had higher rates of major depression, anxiety disorder, conduct disorder, substance use disorder, and suicidal behaviors than those not reporting CSA (p < .002). There were consistent relationships between the extent of CSA and risk of disorder, with those reporting CSA involving intercourse having the highest risk of disorder. These results persisted when findings were adjusted for prospectively measured childhood family and related factors. Similar but less marked relationships between CSA and nonconcurrently measured disorders were found., Conclusions: The findings suggest that CSA, and particularly severe CSA, was associated with increased risk of psychiatric disorder in young adults even when due allowance was made for prospectively measured confounding factors.

Objective: To present accounts of the prevalence of childhood sexual abuse (CSA) and social, family, and related factors that are associated with increased risk of CSA, using data gathered during an 18-year longitudinal study of a New Zealand birth cohort., Method: A birth cohort of more than 1,000 children born in Christchurch (New Zealand) was studied prospectively to the age of 16 years. At age 18, retrospective reports of CSA were obtained., Results: Of the cohort, 10.4% (17.3% of females and 3.4% of males) reported having experienced CSA before the age of 16 years. Rates of severe abusive experiences involving intercourse were lower: 5.6% of females and 1.4% of males reported abuse involving attempted or completed intercouse. Multivariate analyses that the risk of CSA was elevated among females (p < .0001), those exposed to high levels of marital conflict (p < .005), those reporting low parental attachment (p < .001), those reporting high levels of paternal overprotection (p < .005), and those with parents who reported alcoholism/alcohol problems (p < .05). The level of prediction of CSA from childhood and family factors was not sufficient to identify individuals at risk of CSA with any degree of accuracy., Conclusions: CSA was not an uncommon experience in this cohort. Those most likely to be exposed to CSA were girls reared in families in families characterized by high levels of marital conflict and impaired parenting and in families having parents with adjustment problems.

Objective: This paper aims to describe the characteristics of sexually abusive acts experienced by female children in order to identify those perpetrators who inflict intrusive and repeated child sexual abuse (CSA)., Method: Data were collected from a random New Zealand sample of women aged 18 to 65 years who reported CSA, and a similar number of non-abused comparison women. Information on the perpetrator, the type of CSA, and perpetrator strategies were cross-tabulated., Results: The perpetrators were usually young men, well known to the victim or her family. Greater CSA intrusiveness was statistically associated with greater CSA frequency. Father/stepfather abusers were most likely to perpetrate intrusive and frequent CSA. However, family associates and non-paternal relatives were numerically more often reported as perpetrators than fathers/stepfathers. Stranger-perpetrators featured infrequently., Conclusion: We conclude that the most frequent and invasive CSA comes from someone well known to the child, particularly a family member or trusted friend. A focus by the courts or health professionals on either incest only (i.e. CSA between biological relatives) or 'stranger danger' will overlook the large categories of CSA perpetrated by secondary relative and family friend abusers.

The associations between giving a history of physical, emotional, and sexual abuse in children and a range of mental health, interpersonal, and sexual problems in adult life were examined in a community sample of women. Abuse was defined to establish groups giving histories of unequivocal victimization. A history of any form of abuse was associated with increased rates of psychopathology, sexual difficulties, decreased self-esteem, and interpersonal problems. The similarities between the three forms of abuse in terms of their association with negative adult outcomes was more apparent than any differences, though there was a trend for sexual abuse to be particularly associated to sexual problems, emotional abuse to low self-esteem, and physical abuse to marital breakdown. Abuse of all types was more frequent in those from disturbed and disrupted family backgrounds. The background factors associated with reports of abuse were themselves often associated to the same range of negative adult outcomes as for abuse. Logistic regressions indicated that some, though not all, of the apparent associations between abuse and adult problems was accounted for by this matrix of childhood disadvantage from which abuse so often emerged.

The psychological outcome for a random community sample of women who had experienced significant childhood sexual abuse was assessed, using two outcome measures: (i) psychiatric morbidity (measured with the short PSE); (ii) self-esteem. Sexual abused women with a good outcome, i.e. who were not a PSE 'case' or who had high self-esteem were compared with abused women with a poor outcome. This paper describes the post-abuse factors that modified the two outcomes. In general, a range of variables, all correlated with each other in a complex manner, distinguished good outcome subjects from poor outcome subjects. Post-abuse adolescent variables included family factors (poor mother-father and parent-child relationships), high school factors (poor academic, sporting and social performance) and early pregnancy. Women who had a good adolescent relationship with their father did better than expected statistically. Sport emerged as an alternative at secondary school to academic achievement in catalysing a good psychological outcome. Adult factors included the quality of relationship with partner, which was associated with a good outcome on both measures. Current paid employment was linked to high self-esteem but not to lowered psychiatric morbidity, while the converse applied for high socio-economic status. These findings imply that different processes operate for each outcome measure. A clear recognition by the school of childhood sexual abuse may help to provide the opportunity for the girl to experience success in some arena; this in turn may protect her against the likely adult consequences of low self-esteem and increased psychiatric morbidity.

Objective: The assessment of psychiatric status of sexually abused children 12 months after the disclosure of recent sexual abuse., Method: Ninety-five children, aged from 4 through 16 years, were recruited to the study from a variety of agencies other than psychiatric units. Sixty-six (69.5%) were assessed for psychiatric diagnosis on DSM-III-R using data from parents, teachers, and children 12 months after disclosure of abuse. Abuse was extra- and intrafamilial., Results: Overall 63.5% of the children warranted a diagnosis on Axis I. There was a wide range of diagnoses, with particularly high rates of oppositional defiant disorder (19.6%), post-traumatic stress disorder (18.2%), anxiety disorders (30.3%), depressive disorders (12.1%), and attention-deficit hyperactivity disorder (13.6%). Boys had a higher rate of diagnosis than girls. Abuse and social variables did not predict diagnoses but mothers' mental status rated on the General Health Questionnaire did. Subjects not located at follow-up were more often male and more likely to be socioeconomically disadvantaged. Thus the estimates of psychopathology here are likely to be conservative., Conclusions: This study highlights the need of sexually abused children for skilled long-term therapy tailored to individual presentation.

Objective: The study was designed to ascertain the prevalence and nature of sexual abuse in childhood for a community sample of women., Method: A two-stage design, using questionnaires and face-to-face interviews, was employed, providing information on prevalence rates, types of abuse, ages of victims, relationship to the abuser, and cohort effects., Results: Nearly one woman in three reported having one or more unwanted sexual experiences before age 16 years. A significant number of these experiences (70%) involved genital contact or more severe abuse, and 12% of those abused were subjected to sexual intercourse. The abusers were usually known to the victim, being family members in 38.3% of cases and acquaintances in another 46.3%. Stranger abuse accounted for 15% of all abuse experiences. Most of the abusers were young men, disclosure of the abuse was infrequent, and only 7% of all abuse was ever officially reported. Prevalence rates showed no urban/rural differences, no cohort effect with subject age, and no age differences in disclosure rates., Conclusions: Child sexual abuse is common, serious, infrequently reported, and the abuser is usually known to the child. Preadolescent girls are at greatest risk.