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1.
《Child abuse & neglect》2014,38(12):2007-2020
The relation between childhood sexual abuse (CSA) and physical health disorders in adulthood, and what factors may serve as mediators, remains poorly understood. Using data from the 2007 Adult Psychiatric Morbidity Survey (N = 3,486), we tested whether CSA was associated with physical health disorders in adult women and if mediated effects via body mass index (BMI), anxiety/depression, alcohol dependence, and smoking were present. Compared to women with no CSA, women who had experienced CSA involving intercourse had more than twice the odds of being obese, more than 3 times the odds of experiencing mental health disorders, more than 4 times the odds of being alcohol dependent, more than 5 times the odds of being drug dependent, and more than 6 times the odds of attempting suicide. Those experiencing both CSA and child physical abuse (CPA) were on average over 11 kg heavier than those with neither CSA nor CPA. After controlling for demographics, CPA, and childhood bullying, CSA was associated with the majority of physical health disorders studied (typically 50–100% increases in odds). Evidence was found consistent with mediation by BMI (typically accounting for 5–20% increases in odds) and anxiety/depression (typically accounting for 8–40% increases in odds), in a dose-response manner, for the majority of physical health disorders. Bidirectional relations among these mediators and physical health disorders, and residual confounding, may have led to overestimation of mediation through BMI and anxiety/depression and underestimation of mediation through alcohol/smoking. Relations between both CPA and childhood bullying and physical health disorders in adulthood were also found. Longitudinal studies employing more sensitive measures of potential mediators are now required. 相似文献
2.
Exposure to childhood sexual and physical abuse and subsequent educational achievement outcomes 总被引：2，自引：0，他引：2
OBJECTIVE: This paper examined the relationship between exposure to sexual and physical abuse (CSA and CPA) in childhood and later educational achievement outcomes in late adolescence and early adulthood in a birth cohort of over 1,000 children studied to age 25. METHOD: Retrospective data on CSA and CPA were gathered at ages 18 and 21 and used to form a best estimate of exposure to CSA and CPA. The relationship between CSA, CPA, and self-reported educational outcomes to 25 years was examined using logistic regression models that took into account social background, parental factors, and individual factors. RESULTS: Increasing exposure to CSA and CPA was significantly associated with failing to achieve secondary school qualifications (CSA: B=.53, SE=.13, p<.0001; CPA: B=.62, SE=.12, p<.0001), gaining a Higher School Certificate (CSA: B=-.48, SE=.13, p<.001; CPA: B=-.78, SE=.14, p<.001), attending university (CSA: B=-.29, SE=.13, p<.05; CPA: B=-.45, SE=.13, p<.001), and gaining a university degree (CSA: B=-.54, SE=.18, p<.005; CPA: B=-.64, SE=.17, p<.001). Adjustment for confounding social, parental, and individual factors explained most of these associations. After control for confounding factors, omnibus tests of the associations between CSA and outcomes and CPA and outcomes failed to reach statistical significance (CSA: Wald chi(2) (4)=7.72, p=.10; CPA: Wald chi(2) (4)=8.26, p=.08). CONCLUSIONS: The effects of exposure to CSA and CPA on later educational achievement outcomes are largely explained by the social, family, and individual context within which exposure to abuse takes place. 相似文献
3.
Objective: The aims of this study were to identify the factors which discriminated young people exposed to childhood sexual abuse (CSA) who developed psychiatric disorder or adjustment difficulties in young adulthood from those young people exposed to CSA who did not develop psychiatric disorder or adjustment difficulties by age 18.Method: Data were gathered on a birth cohort of 1,025 New Zealand children studied from birth to the age of 18 on (a) exposure to CSA; (b) patterns of psychiatric disorder and adjustment difficulties at age 18 years; (c) factors that may have influenced responses to CSA including characteristics of the abuse, parental bonding, parental characteristics, and adolescent peer affiliations.Results: Just over 10% of the cohort reported CSA. Those reporting CSA were at increased risks of a range of difficulties at age 18 (depression, anxiety, conduct disorder, alcohol abuse/dependence, other substance abuse/dependence, post sexual abuse trauma, attempted suicide). However, not all of those exposed to CSA developed difficulties and approximately a quarter of those exposed to CSA did not meet criteria for any adjustment difficulty. Further analysis suggested that the extent of adjustment difficulties in those exposed to CSA was influenced by two additional factors: (a) the extent of affiliations with delinquent or substance using peers in adolescence; and (b) the extent of paternal care or support in childhood.Conclusions: The findings of this study suggest that while young people exposed to CSA are at increased risks of psychiatric disorder and adjustment difficulties in young adulthood, not all individuals exposed to CSA will develop adjustment difficulties. Important factors protecting against the development of adjustment difficulties in young people experiencing CSA appear to be the nature and quality of peer and family relationships. 相似文献
4.
OBJECTIVE: This study examined the relationships between childhood and family background variables, including sexual and physical abuse, and subsequent alcohol abuse and psychological distress in adult lesbians. METHODOLOGY: Structural equation modeling was used to evaluate relationships between childhood sexual and physical abuse and parenting variables and latent measures of lifetime alcohol abuse and psychological distress in a large community-based sample of lesbians. RESULTS: Childhood sexual abuse (CSA) directly predicted lifetime alcohol abuse, and childhood physical abuse (CPA) directly predicted lifetime psychological distress. In addition, CSA indirectly increased the risk of lifetime alcohol abuse through its negative effect on age at first heterosexual intercourse. Childhood physical abuse had only indirect effects on lifetime alcohol abuse through its strong relationship to lifetime psychological distress. Parental drinking problems and parental strictness directly predicted lifetime psychological distress; parental drinking problems indirectly predicted lifetime alcohol abuse through the mediators of age of drinking onset and lifetime psychological distress. White lesbians, younger lesbians, and those with lower levels of education were at greatest risk of psychological distress. CONCLUSION: While the cross-sectional design precludes causal conclusions, study findings--especially those related to CSA--are consistent with previous research on predominantly heterosexual women in the general population. Lesbians who experienced CSA were at heightened risk of lifetime alcohol abuse and those who experienced CPA were at heightened risk of lifetime psychological distress relative to lesbians without abuse histories. Given the dearth of research on childhood abuse and sexual orientation, studies are needed that examine the similarities and differences between lesbians' and heterosexual women's experiences of, and responses to, childhood abuse. 相似文献
5.
OBJECTIVE: This study had two primary objectives: First, to examine the association between childhood sexual abuse (CSA) and later parenting characteristics, particularly physical abuse potential, and second, to explore maternal anger as a mediator of the relationship between CSA and adult physical abuse potential. METHOD: Utilized a community sample of low SES participants that included 138 mothers classified as having experienced CSA, and a comparison group of 152 non-sexually abused mothers. Parenting variables examined included the mothers' physical abuse potential, nurturance toward their children, unrealistic developmental expectations of children, as well as frequencies of spanking and general punishment. Data was collected via interview and other self-report measures. RESULTS: Even after controlling for mothers' childhood experience of Physical abuse, CSA significantly predicted adult risk of physically abusing one's own children. Further, maternal anger was confirmed as a mediator of the relationship between having been sexually abused as a child and the potential for physically abusing one's own children. CONCLUSIONS: CSA may be a risk factor for subsequent physically abusive parenting, while anger appears to play a significant role in mediating this relationship. Findings are discussed in the context of current knowledge concerning the impact of child sexual abuse and the processes contributing to abusive parenting. 相似文献
6.
BackgroundA history of childhood abuse and neglect (CAN) is associated with exposure to later negative life events. CAN at an early age, multiple cooccurring exposures (cumulative events), and a high severity and frequency of exposure have potential detrimental long-term effects.ObjectiveThe present study examines the relationship between the severity of CAN and the prevalence of school difficulties and hardship at school, adult adversity and mental health.Participants and Settings: Participants were recruited from in- and outpatient mental health or substance abuse treatment facilities, child protective services (CPS), and prisons (N = 809, age range = 13–66, mean age = 27.62, SD = 10.47).MethodsExposure to childhood maltreatment was assessed by the Childhood Trauma Questionnaire Short Form (CTQ-SF). After adjusting for gender and age, we conducted a risk ratio regression analysis to investigate associations between severity of child abuse and neglect and hardship at school, adult adversity and adult mental health.ResultsThe moderate and severe level groups of CAN had statistically significant higher risk ratios for experiences of school difficulties, hardship at school, adult adversity and mental health problems. A robust dose-response was found between severity levels.ConclusionAt an individual level the findings highlight the association between exposure to abuse and adult adversity, underscoring the importance of targeting individuals with high risk of exposure to CAN to reduce the negative long-term risk for Polyvictimization. 相似文献
7.
K D Scott 《Child abuse & neglect》1992,16(2):285-295
Epidemiologists have used impact fractions (e.g., attributable fractions) to study the influence of various risk factors on the rates of physical diseases within the community. In this study, impact fractions are applied to a psychiatric epidemiologic problem in order to examine the impact of childhood sexual abuse (CSA) on the mental health status of a community. Analysis of the Los Angeles Epidemiologic Catchment Area (LAECA) data indicate that a history of CSA significantly increases an individual's odds of developing eight psychiatric disorders in adulthood. On the community level, however, it is estimated that 74% of the exposed psychiatric cases (i.e., those with a history of CSA), and 3.9% of all psychiatric cases within the population can be attributed to childhood sexual abuse. Intervention implications are discussed. 相似文献
8.
This study systematically reviews research on child maltreatment and risk of gambling problems in adulthood. It also reviews adult problem gamblers’ risk of abusing or neglecting their own children. Multiple database searches were conducted using pre-defined search terms related to gambling and child abuse and neglect. We identified 601 unique references and excluded studies if they did not report original research, or did not specifically measure child maltreatment or gambling. Twelve studies that included multivariable analysis of childhood maltreatment exposure and problem gambling were identified. Six of seven studies examining childhood sexual abuse and four of five examining physical abuse showed a significant positive association between abuse and later gambling problems (odds ratios for sexual abuse 2.01–3.65; physical abuse 2.3–2.8). Both studies examining psychological maltreatment and two of three examining neglect identified positive associations with problem gambling. In most studies, risks were reduced or eliminated when controlling for other mental health disorders. The three studies measuring risk of child abuse and neglect among current problem gamblers suggest an increased risk for child physical abuse and medical conditions indicative of neglect although there is a considerable amount of variation among studies. Child abuse is associated with increased risk of gambling problems – gambling treatment providers should ask about maltreatment history as part of their clinical assessment. Problem gamblers may be more likely to physically abuse or neglect their children, but data here are more limited. Child welfare professionals should consider asking questions about parental gambling when assessing family risk. 相似文献
9.
Children who have been exposed to maltreatment and other adverse childhood experiences (ACEs) are at increased risk for various negative adult health outcomes, including cancer, liver disease, substance abuse, and depression. However, the proximal associations between ACEs and behavioral outcomes during the middle childhood years have been understudied. In addition, many of the ACE studies contain methodological limitations such as reliance on retrospective reports and limited generalizability to populations of lower socioeconomic advantage. The current study uses data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort, to prospectively assess the adverse experiences and subsequent behavior problems of over 3000 children. Eight ACE categories to which a child was exposed by age 5 were investigated: childhood abuse (emotional and physical), neglect (emotional and physical), and parental domestic violence, anxiety or depression, substance abuse, or incarceration. Results from bivariate analyses indicated that Black children and children with mothers of low education were particularly likely to have been exposed to multiple ACE categories. Regression analyses showed that exposure to ACEs is strongly associated with externalizing and internalizing behaviors and likelihood of ADHD diagnosis in middle childhood. Variation in these associations by racial/ethnic, gender, and maternal education subgroups are examined. This study provides evidence that children as young as 9 begin to show behavioral problems after exposure to early childhood adversities. 相似文献
10.
OBJECTIVE: Child maltreatment has been linked to negative adult health outcomes; however, much past research includes only clinical samples of women, focuses exclusively on sexual abuse and/or fails to control for family background and childhood characteristics, both potential confounders. Further research is needed to obtain accurate, generalizable estimates and to educate clinicians who are generally unaware of the link between childhood abuse and adult health. The purpose of this project is to examine how childhood physical abuse by parents impacts mid-life mental and physical health, and to explore the attenuating effect of family background and childhood adversities. METHODS: We analyzed population-based survey data from over 2,000 middle-aged men and women in the Wisconsin Longitudinal Study using self-reported measures of parental childhood physical abuse, mental health (depression, anxiety, anger), physical health (physical symptoms and medical diagnoses), family background, and childhood adversities. RESULTS: Parental physical abuse was reported by 11.4% of respondents (10.6% of males and 12.1% of females). In multivariate models controlling for age, sex, childhood adversities, and family background, we found that childhood physical abuse predicted a graded increase in depression, anxiety, anger, physical symptoms, and medical diagnoses. Childhood physical abuse also predicted severe ill health and an array of specific medical diagnoses and physical symptoms. Family background and childhood adversities attenuated but did not eliminate the childhood abuse/adult health relationship. CONCLUSIONS: In a population-based cohort of middle-aged men and women, childhood physical abuse predicted worse mental and physical health decades after the abuse. These effects were attenuated, but not eliminated, by age, sex, family background, and childhood adversities. 相似文献
11.
Child sexual abuse (CSA) can have a profound effect on the long-term mental health of boys/men. However, not all men with histories of CSA experience psychopathology. To improve prevention and intervention services, more research is needed to understand why some male survivors experience mental health problems and others do not. The purpose of this study was to examine factors related to mental distress among a large, non-clinical sample of men with histories of CSA (N = 487). Using a cross-sectional design with purposive sampling from three national survivor organizations, data were collected through an anonymous Internet-based survey. Multivariate analyses found that only one of the four CSA severity variables—use of physical force by the abuser—was related to mental distress. Additional factors that were related to mental distress included the number of other childhood adversities, years until disclosure, overall response to disclosure, and conformity to masculine norms. Overall, the final model predicted 36% of the variance in the number of mental health symptoms. Mental health practitioners should include masculine norms, disclosure history, and childhood adversities in assessments and intervention planning with male survivors. To more fully explicate risk factors for psychopathology in this population, future studies with probability samples of men that focus on mediational processes and use longitudinal designs are needed. 相似文献
12.
Quas JA Goodman GS Ghetti S Alexander KW Edelstein R Redlich AD Cordon IM Jones DP 《Monographs of the Society for Research in Child Development》2005,70(2):vii, 1-vii128
We report a longitudinal study of long-term outcomes of participating in criminal cases following child sexual abuse (CSA). In the 1980s, 218 child victim/witnesses took part in a study of short-term sequelae of legal involvement. Approximately 12 years later, 174 of them, as well as a comparison group of 41 matched individuals with no CSA history, were interviewed about their mental health and legal attitudes. Being young when the legal case started was associated with poorer later adjustment. Additionally, even when controlling for psychological problems at the start of the legal case and other familial, CSA, and life stressors, testifying repeatedly in childhood predicted poorer current functioning. These associations were often moderated by the severity of both the CSA and the perpetrator's sentence: Testifying repeatedly in cases involving severe abuse, and not testifying when the perpetrator received a light sentence, predicted poorer current mental health. In partial contrast to the mental health results, being older when the case began and the perpetrator receiving a lenient sentence predicted more negative feelings about the legal system. In addition, not having testified when the perpetrator received a light sentence predicted more negative legal attitudes. Individuals' emotional reactions while waiting to testify and while actually testifying were also associated with their current mental health and attitudes toward the legal system: Greater distress predicted poorer adjustment, especially in individuals who were adolescents when they went to court. Greater distress also predicted more negative attitudes. Finally, when the former CSA victim/witnesses were compared with individuals with no CSA history, the former reported poorer adjustment and more negative feelings about the legal system. Results have implications for multilevel-transactional models of development, for understanding developmental sequelae of legal involvement following childhood trauma, and for social policy concerning the treatment of child victim/witnesses. 相似文献
13.
Rodgers CS Lang AJ Laffaye C Satz LE Dresselhaus TR Stein MB 《Child abuse & neglect》2004,28(5):575-586
OBJECTIVE: This study examines the unique contribution of five types of maltreatment (sexual abuse, physical abuse, emotional abuse, physical neglect, emotional neglect) to adult health behaviors as well as the additive impact of exposure to different types of childhood maltreatment. METHOD: Two hundred and twenty-one women recruited from a VA primary care clinic completed questionnaires assessing exposure to childhood trauma and adult health behaviors. Regression models were used to test the relationship between childhood maltreatment and adult health behaviors. RESULTS: Sexual and physical abuse appear to predict a number of adverse outcomes; when other types of maltreatment are controlled, however, sexual abuse and physical abuse do not predict as many poor outcomes. In addition, sexual, physical, and emotional abuse and emotional neglect in childhood were all related to different adult health behaviors. The more types of childhood maltreatment participants were exposed to the more likely they were to have problems with substance use and risky sexual behaviors in adulthood. IMPLICATIONS: The results indicate that it is important to assess a broad maltreatment history rather than trying to relate specific types of abuse to particular adverse health behaviors or health outcomes. 相似文献
14.
《Child abuse & neglect》2014,38(12):1955-1965
Evidence on the relationship of adolescent exposure to violence (AEV) with adult physical and mental health problems is limited, with studies often focusing on earlier childhood rather than adolescence, and also on short term rather than long term outcomes. Information specifically on the relationship of AEV to seeking help for mental health problems in adulthood from either formal sources such as mental health professionals or informal sources such as friends and clergy is even more difficult to find. The present study investigates how adolescent exposure to violence (AEV), in the form of parental physical abuse, witnessing parental violence, and exposure to violence in the neighborhood, are related to self-reported adult physical problems and seeking formal or informal assistance with mental health, controlling for more general adolescent violent victimization and for self-reports and parent reports of mental health problems in adolescence. This study adds to the literature on AEV and adult physical problems, and provides a rare look at the relationship of AEV to adult help-seeking for mental health problems. The results suggest that AEV is associated with mental health problems in adolescence for both females and males, that for females AEV is related to physical problems and to seeking help for mental health problems in adulthood, but for males the only significant relationship involves inconsistent reports of witnessing parental violence and adult physical problems. 相似文献
15.
OBJECTIVE: The aim of this study was to examine the association between childhood sexual abuse (CSA) and a range of adverse adult outcomes in a community sample of women using multivariate analysis which accounted for a number of potential confounding effects. METHOD: Retrospective study of cross-sectional data on the long-term impact 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. RESULTS: Significant associations were found between reporting CSA and experiencing domestic violence, rape, sexual problems, mental health problems, low self-esteem, and problems with intimate relationships even after taking into account a range of family background factors. Women who had experienced abuse involving intercourse were the most vulnerable to these negative outcomes. CONCLUSIONS: The findings indicate that the influence of CSA on adverse long-term effects is mediated and influenced both by the severity of the abuse experiences and by a range of family and social background factors. 相似文献
16.
Physical punishment, childhood abuse and psychiatric disorders 总被引：1，自引：0，他引：1
OBJECTIVES: Physical punishment, as a means of disciplining children, may be considered a mild form of childhood adversity. Although many outcomes of physical punishment have been investigated, little attention has been given to the impact of physical punishment on later adult psychopathology. Also, it has been stated that physical punishment by a loving parent is not associated with negative outcomes; however, this theory has not been empirically tested with regard to psychiatric disorders. The main objective of the present study was to investigate three categories of increasing severity of childhood adversity (no physical punishment or abuse, physical punishment only, and child abuse) to examine whether the childhood experience of physical punishment alone was associated with adult psychopathology, after adjusting for sociodemographic variables and parental bonding dimensions. METHODS: Data were drawn from the nationally representative National Comorbidity Survey (NCS, n=5,877; age 15-54 years; response rate 82.4%). Binary logistic and multinomial logistic regression models were used to determine the odds of experiencing psychiatric disorders. RESULTS: Physical punishment was associated with increased odds of major depression (AOR=1.22; 95% CI=1.01-1.48), alcohol abuse/dependence (AOR=1.32; 95% CI=1.08-1.61), and externalizing problems (AOR=1.30; 95% CI=1.05-1.60) in adulthood after adjusting for sociodemographic variables and parental bonding dimensions. Individuals experiencing physical punishment only were at increased odds of adult psychopathology compared to those experiencing no physical punishment/abuse and at decreased odds when compared to those who were abused. CONCLUSIONS: Physical punishment is a mild form of childhood adversity that shows an association with adult psychopathology. 相似文献
17.
Child maltreatment has consistently been found to be associated with attention deficit/hyperactivity disorder (ADHD). However, the robustness of this association and the direction of the link between maltreatment and ADHD remain unclear. We used data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a cohort of 2232 British twins, to investigate the associations between exposure to abuse/neglect and ADHD in childhood and in young adulthood, and to test their robustness and specificity. We also aimed to test longitudinal associations between abuse/neglect and ADHD from childhood to young adulthood, controlling for confounders. Results indicated strong associations between abuse/neglect and ADHD in childhood and also in young adulthood. In childhood, the association was concentrated among children with comorbid conduct disorder. Longitudinal analyses showed that childhood ADHD predicted abuse/neglect in later years. This association was again concentrated among individuals with comorbid conduct disorder. Abuse/neglect in childhood was not associated with later ADHD in young adulthood after adjusting for childhood ADHD. Our study does not provide support of a causal link between child abuse/neglect and adult ADHD but highlights the possibility of a long-term effect of disruptive behaviors on the risk for experiencing abuse/neglect. These findings emphasize the need for clinicians treating people with ADHD, especially those with comorbid conduct disorder, to be aware of their increased risk for experiencing abuse/neglect. Interventions aimed at reducing risks of abuse/neglect should also focus on the environment of individuals with disruptive behaviors. 相似文献
18.
Child maltreatment has well-documented long-term, adverse effects on mental health, but it is not clear whether there are gender differences in these effects. We conducted a systematic review to investigate whether there are gender differences in the effects of maltreatment on adult depression and anxiety. Medline, PsycINFO, Web of Science, and Lilacs were searched for relevant studies published up to May 2016. Eligible studies included population-based studies (with a cohort, case-control or cross-sectional design) which assessed maltreatment during childhood or adolescence (≤18 years) and its association with major depression or generalized anxiety disorder (DSM/ICD diagnostic criteria) in adulthood (>18 years) separately for females and males. Meta-analysis was performed to estimate the association between each exposure and outcome using fixed and random effects models. Pooled odds ratios (OR) were estimated separately for women and men and compared. Five studies of physical and sexual abuse were included in the meta-analyses. These provided twenty-two effects sizes estimates (11 for men, 11 for women) for associations between physical/sexual abuse and depression/anxiety. Exposure to each kind of abuse increased the odds of depression/anxiety. Associations were larger for women than for men, however, these gender differences were not statistically significant. Physical and sexual abuse in childhood/adolescence are risk factors for depression/anxiety in adulthood and the effect could be larger for women; however, currently there is insufficient evidence to definitively identify gender differences in the effects of maltreatment. 相似文献
19.
INTRODUCTION: To identify possible gaps in the child maltreatment literature the present study examined the development of the child maltreatment literature over a 22-year period, including temporal trends for child maltreatment types, the characteristics of the research participants, and sources of participant recruitment. METHOD: Child maltreatment articles (N=2090) published from 1977 to 1998 (inclusive) in six specialty journals were coded on type of article, type of child maltreatment, gender and parental status of participants, abuse role of participants, and recruitment source of participants. RESULTS: Across the period studied the annual percentage of quantitative articles (articles with inferential statistics) increased, whereas the annual percentage of theoretical articles decreased. The annual percentage of articles examining child physical abuse (CPA) decreased, whereas the annual percentage of articles examining child sexual abuse (CSA) increased. The percentages of articles examining child neglect (CN) or child emotional abuse (CEA) remained consistently low. Distinguishing child maltreatment types in research articles increased. Males were underrepresented in CPA perpetration and CPA adult victimization articles, but adequately represented in CSA perpetration and CPA child victimization articles. Females were adequately represented in CPA perpetration and CSA child and adult victimization articles. Recruitment from universities and outpatient mental health facilities increased; recruitment from medical settings decreased. CONCLUSIONS: CN and CEA literatures need to be developed first by theoretical, then by quantitative works. In addition, the publication of more research on male subjects for CPA perpetration and adult CPA victimization is needed. 相似文献
20.
We examine associations between childhood sexual abuse (CSA) and substance abuse, the role of mental health indicators as mediators in these associations and whether or not associations differ by gender. Data are from 14,063 respondents aged 18–76 years from the 2004–2005 Canadian Gender, Alcohol, and Culture: An International Study (GENACIS). Multiple logistic regression models were used to examine associations between CSA and substance abuse variables, controlling for socio-demographic factors. Odds were adjusted by indicators of mental health to assess if these variables mediated associations between CSA and substance abuse. Tests of interactions between sex and CSA were conducted to see if gender differences exist in associations. In 2004/2005, CSA was reported by 14% of women and 5% of men. CSA was associated with heavy drinking, hazardous drinking, and the use of marijuana, other illicit drugs, and off-label drugs. Associations were only very marginally attenuated when controlling for depression and self-perceived emotional/mental health. In all cases previously observed significant associations persisted. Evidence of gender differences in associations between CSA and substance abuse was negligible. Preventing CSA may also reduce substance abuse. 相似文献