Exploration of mental health outcomes of community-based intervention programs for adult male survivors of childhood sexual abuse
This study aims to evaluate the effectiveness of clinical treatment for male survivors of childhood sexual abuse (CSA) who deal with depression, anxiety, stress, and posttraumatic stress disorder (PTSD). Secondary data was used in the study, and a one-group pretest-posttest design was employed to compare pretest (n = 346) with posttest (n = 91) scores. The analysis shows statistically significant improvements with respect to depression, anxiety, stress, and PTSD after treatment. There was no statistically significant difference between individual and mixed treatment (including group and individual counselling) regarding alleviating mental health symptoms. Despite a lack of statistical difference between treatments, the results confirm that interventions were equally effective in reducing negative mental health symptoms. The study contributes to the generation of evidence-based knowledge for treatment and its ability to reduce negative mental health symptoms for adult male survivors of CSA. It also informs practitioners of the utility of a male-specific treatment modality based on trauma-focused cognitive and behavioral therapies (TF-CBT) and the gender role strain paradigm (GRSP).
Key Words: Adult Male Survivors, Childhood Sexual Abuse, Mental Health, Evaluation
Alaggia, R & Millington, G 2008, ‘Male child sexual abuse: a phenomenology of betrayal’, Clinical Social Work Journal, vol. 36, no. 3, pp. 265-75, doi: 10.1007/s10615-007-0144-y.
American Psychiatric Association 1994, Diagnostic and statistical manual of mental disorders, 4th edn, Washington.
American Psychiatric Association 2017, What is depression?, viewed 20 November 2018, https://www.psychiatry.org/patients-families/depression/what-is-depression
Antony, MM, Bieling, P J, Cox, B.J, Enns, MW & Swinson, RP 1998, ‘Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scale in clinical groups and a community sample’, Psychological Assessment, vol. 10, no. 2, pp. 176–81, doi: 10.1037/1040-35126.96.36.199.
Asukai, N, Kato, H, Kawamura, N, Kim, Y, Yamamoto, K, Kishimoto, J, Miyake, Y, & Nishizono-Maher, A 2002, ‘Reliability and validity of the Japanese-Language version of the Impact of Event Scale-Revised (IES-R-J): four studies of different traumatic’, Journal of Nervous and Mental Disease, vol. 190, no. 3, pp. 175–82, http://psycnet.apa.org/doi/10.1097/00005053-200203000-00006
Baguena, M, Villarroya, E, Belena, A, Amelia, D, Roldan, C & Reig, R 2001, ‘Propiedades psicometricas de la version Espanola de la Escala Revisada de Impacto del Estressor (EIE-R) [Psychometric properties of the Spanish version of the Impact of Event Scale – Revised (IES-R)]’, Analisis y Modificacion de Conducta, vol. 27, pp. 581–604, viewed 20 November 2018, < https://www.uv.es/baguena/art-IES-R.pdf>.
Banyard, VL, Williams, LM & Siegel, JA 2004, ‘Childhood sexual abuse: a gender perspective on context and consequences’, Child Maltreatment, vol. 9, no. 3, pp. 223-38, doi: 10.1177/107755904266914.
Beck, JG, Grant, DM, Read, JP, Clapp, JD, Coffey, SF, Miller, LM & Palyo, SA 2008, ‘The Impact of Event Scale-Revised: psychometric properties in a sample of motor vehicle accident survivors’, Journal of Anxiety Disorders, vol. 22, no. 2, pp. 187-198, doi:10.1016/j.janxdis.2007.02.007.
Brier, J & Elliott, DM 2003, ‘Prevalence and symptomatic sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women’, Child Abuse & Neglect: The International Journal, vol. 27, pp. 1205-1222, https://doi.org/10.1016/j.chiabu.2003.09.008.
Brunet, A, St-Hilaire, A, Jehel, L & King, S 2003, ‘Validation of a French version of the Impact of Event Scale-Revised’, Canadian Journal of Psychiatry, vol. 48, no. 1, pp. 56–61, doi:10.1177/070674370304800111.
Butler, AC, Chapman, JE, Forman, EM & Beck, AT 2006, ‘The empirical status of cognitive-behavioral therapy: a review of meta-analyses’, Clinical Psychology Review, vol. 26, pp. 17–31. doi: 10.1016/j.cpr.2005.07.003.
Center for Disease Control and Prevention 2010, Adverse child experiences study, viewed 20 November 2018, <http://www.cdc.gove/nccdphp/ace/prevlaence.htm>.
Chard, KM 2005, ‘An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse’, Journal of Consulting and Clinical Psychology, vol. 73, no. 5, pp. 965–971, doi: 10.1037/0022-006X.73.5.965.
Clara, IP, Cox, BJ & Enns, MW 2001, ‘Confirmatory factor analysis of the Depression Anxiety Stress Scales in depressed and anxious patient’, Journal of Psychopathology and Behavioral Assessment, vol. 23, no. 1, pp. 61–67. doi: 10.1023/A:1011095624717.
Cohen, J 1988, Statistical power analysis for the behavioral sciences, Routledge Academic, New York.
Courtois, CA 1988, Healing the incest wound: adult survivors in therapy, W. W. Norton & Company, New York.
Crawford, JR & Henry, JD 2003, ‘The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample’, British Journal of Clinical Psychology, vol. 42, no. 2, pp. 111–131, doi 10.1348/014466503321903544.
Creamer, M, Bell, R & Failla, S 2003, ‘Psychometric properties of the impact of event scale-revised’, Behaviour Research and Therapy, vol. 41, no. 12, pp 1489–1496, doi: 10.1016/j.brat.2003.07.010.
Cuddeback, G, Wilson, E, Orme, JG & Combs-Orme, T 2004, ‘Detecting and statistically correcting sample selection bias’, Journal of Social Service Research, vol. 30, no. 3, pp. 19-33, doi: 10.1300/J079v30n03_02.
Doane, DP & Seward, LE 2011, ‘Measuring skewness: a forgotten statistic?’, Journal of Statistics Education, vol. 19, no. 2, pp. 1-18. viewed 21 November 2018, <http://ww2.amstat.org/publications/jse/v19n2/doane.pdf>.
Dube, R, Anda, R, Whitfield, C, Brown, D, Felitti, V, Dong, M & Giles, W 2005, ‘Long-term consequences of childhood sexual abuse by gender of victim’, American Journal of Preventative Medicine, vol. 28, no. 5, pp. 430-438, doi: 10.1016/j.amepre.2005.01.015.
Du Toit, SHC & du Toit, M 2001, Interactive LISREL: User’s guide. Scientific Software International, Lincolnwood.
Easton, SD, Renner, LM & O’Leary, P 2013, ‘Suicide attempts among men with histories of child sexual abuse: examining abuse severity, mental health, and masculine norms’, Child Abuse and Neglect, vol. 37, no. 6, pp. 380-387, doi: 10.1016/j.chiabu.2012.11.007.
Ferguson, C 2014, Art therapy for adult survivors of child sexual abuse, Master of Social Work, Electronic Theses, California State University, viewed 22 November 2018, < https://scholarworks.lib.csusb.edu/etd/56/>.
Fergusson, DM, McLeod, GF & Horwood, LJ 2013, ‘Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand’, Child Abuse and Neglect, vol. 37, no. 9, pp. 664-674, doi: 10.1016/j.chiabu.2013.03.013.
Fisher, A, Goodwin, R & Patton, M 2009, Men & healing: theory, research, and practice in working with male survivors of childhood sexual abuse: A guidebook, Living Well, viewed, 22 November 2018, <https://www.livingwell.org.au/wp-content/uploads/2012/11/Men_and_Healing_2008.pdf>.
Fuller-Thomson, E, Began, R, Hunter, JT, Grundland, T & Brennenstuhl, S 2012, ‘The link between childhood sexual abuse and myocardial infarction in a population-based study’, Child Abuse and Neglect, vol. 36, no. 9, pp. 656-665, doi: 10.1016/j.chiabu.2012.06.001.
Gastwirth, JL, Gel, YR & Miao, W 2009, ‘The impact of Levene’s Test of Equality of Variance on statistical theory and practice’, Statistical Science, vol. 24, no. 3, pp. 434-460, viewed 21 November 2018, <https://arxiv.org/pdf/1010.0308.pdf>.
Gilbert, R, Widom, CS, Browne, K, Fergusson, D, Webb, E & Janson, S 2009, ‘Burden and consequences of child maltreatment in high income countries’, The Lancet, vol. 373, pp. 68-81, doi: 10.1016/S0140-6736(08)61706-7.
Gregory, B. M. (2010). CBT skills workbook: practical exercises and worksheets to promote change, PESI Publishing and Media, Eau Claire.
Heman, JL & Schatzow, E 1984, ‘Time-limited group therapy for women with a history of incest’, International Journal of Group Psychotherapy, vol. 34, no. 4, pp. 605-615, https://doi.org/10.1080/00207284.1984.11732563.
Holmes WC, Foa, EB & Sammel, MD 2005, ‘Men’s pathways to risky sexual behavior: role of co-occurring childhood sexual abuse, posttraumatic stress disorder, and depression histories’, Journal of Urban Health: Bulletin of the New York Academy of Medicine, vol. 82, pp. 89-99, doi: 10.1093/jurban/jti028.
Holmes, W & Slap, G 1998, ‘Sexual abuse of boys: definition, prevalence, correlates, sequelae, and management’, Journal of the American Medical Association, vol. 280, pp. 1855-1862. viewed 21 November 2018, <https://www.jimhopper.com/pdf/Holmes_&_Slap_1998.pdf>.
Hopper, J 2010, Sexual abuse of males: prevalence, possible lasting effects, and resources. viewed 20 November 2018, <http://www.jimhopper.com>.
Horowitz, M, Wilner, N & Alvarez, W 1979, ‘Impact of Event Scale: a measure of subjective stress’, Psychosomatic Medicine, vol. 41, no. 3, pp. 209-218. viewed 21 November 2018, <https://www.ncbi.nlm.nih.gov/pubmed/472086>.
Kessler, MRH, White, MB & Nelson, BS 2003, ‘Group treatments for women sexually abused as children: a review of the literature and recommendations for future outcome research’, Child Abuse & Neglect, vol. 27, no. 9, pp. 1045-1061, doi: 10.1016/S0145-2134(03)00165-0.
Kia-Keating, M, Grossman, FK, Sorsoli, L & Epstein, M 2005, ‘Containing and resisting masculinity: narratives of renegotiation among resilient male survivors of childhood sexual abuse’, Psychology of Men & Masculinity, vol. 6, no. 3, pp. 169-185, doi: 10.1037/1524-9188.8.131.52.
Kraftcheck, ER, Muller, RT & Wright, DC 2007, ‘Treatment of depressive symptoms in adult survivors of childhood trauma’, Journal of Aggression, Maltreatment & Trauma, vol. 15, no. 1, pp. 37-58, doi: 10.1300/J146v15n01_03.
Kreuger, LW & Neuman, WL 2006, Social work research methods: qualitative and quantitative applications, Pearson & Allyn Bacon, New York.
Levant, R.F 2011, ‘Research in the psychology of men and masculinity using the gender role strain paradigm as a framework’, American psychologist, vol. 66, no. 8, pp. 765-776. doi: 10.1037/a0025034.
Lisak, D 1997, ‘Male gender socialization and the perpetration of sexual abuse’, in RF Levant & GR Brooks (eds), Men and sex: new psychological perspectives, John Wiley & Sons, New York, pp. 156-177.
Lovibond, SH & Lovibond, PF 1995a, Manual for the Depression Anxiety Stress Scales, 2nd edn, Psychology Foundation, Sydney.
Lovibond, PH & Lovibond, SH 1995b, ‘The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories’, Behavior Research and Therapy, vol. 33, no. 1, pp. 335-343, viewed 20 November 2018, <https://doi.org/10.1016/0005-7967(94)00075-U>.
Lowe, M, Wilan, VJ, Kelly, S, Hartwell, B & Canuti, E 2017, ‘CORE assessment of adult survivors abused as children: a NAPAC group therapy evaluation’, Counselling and Psychotherapy Research, vol. 17, no. 1, pp. 71-79, https://doi.org/10.1002/capr.12095.
Maercker, A & Schützohl, M 1998, ‘Assessment of post-traumatic stress reactions: the Impact of Event Scale-Revised (IES-R)’, Diagnostica, vol. 44, no. 3, pp. 130-141, viewed 20 November 2018, <https://www.aerztenetz-grafschaft.de/download/IES-R-englisch-5-stufig.pdf>.
Mahalik, J, Talmadge, T, Locke, B & Scott, R 2005, ‘Using the conformity to masculine norms inventory to work with men in a clinical setting’, Journal of Clinical Psychology, vol. 61, no. 6, pp. 661-674, doi: 10.1002/jclp.20101.
Martin, WE & Bridgmon, KD 2012, Quantitative and statistical research methods: from hypothesis to results, Wiley, Somerset.
Masten, J. (2007). ‘A short–term group treatment model for gay male survivors of childhood sexual abuse living with HIV/AIDS’, International Journal of Group Psychotherapy, vol. 57, no. 4, pp. 475-496, https://doi.org/10.1521/ijgp.2007.57.4.475.
McDonagh, A, Friedman, M, McHugo, G, Ford, J, Sengupta, A, Mueser, K, Demment, CC, Fournier D, Schnurr PP & Descamps, M 2005, ‘Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse’, Journal of Consulting and Clinical Psychology, vol. 73, no. 3, pp. 515-524, doi: 10.1037/0022-006X.73.3.515.
Meade, CS, Drabkin, AS, Hansen, NB, Wilson, PA, Kochman, A & Sikkema, KJ 2010, ‘Reductions in alcohol and cocaine use following a group coping intervention for HIV-positive adults with childhood sexual abuse histories’, Addiction, vol. 105, no. pp. 1942–1951, https://doi.org/10.1111/j.1360-0443.2010.03075.x.
Ministry of the Attorney General 2015, Support services for male survivors of sexual abuse program; Program standards, victims and vulnerable persons. Viewed 20 November 2018, Internal document, Victims and Vulnerable Persons Division, Ontario Victim Services.
Murray, LK, Skavenski, S, Michalopoulos, LM, Bolton, PA, Bass, JK, Familiar, I & Cohen, J 2014, ‘Counsellor and participant perspectives of trauma-focused cognitive behavioural therapy for children in Zambia: a qualitative study’, Journal of Clinical Child and Adolescent Psychology, vol. 43, no. 6, pp. 902-914, doi: 10.1080/15374416.2013.859079.
Navarro, N & Clevenger, S 2017, ‘Calling attention to the importance of assisting male survivors of sexual victimization’, Journal of School Violence, vol. 16, no. 2, pp. 222–235, doi: 10.1080/15388220.2017.1284478.
Nisbet Wallis, DA 2002, ‘Reduction of trauma symptoms following group therapy’, Australian and New Zealand Journal of Psychiatry, vol. 36, pp. 67–74, https://doi.org/10.1046/j.1440-1614.2002.00980.x
Nunnally, JC 1978, Psychometric theory, McGraw-Hill, New York.
Olde, E, Kleber, RJ, van der Hart, O & Pop, VJM, 2006, ‘Childbirth and posttraumatic stress responses: a validation study of the Dutch Impact of Event Scale-Revised’, European Journal of Psychological Assessment, vol. 22, no. 4, pp. 259-267, doi: 10.1027/1015-57184.108.40.2069.
Padmanabhanunni, A & Edwards, D 2016, ‘Rape survivors' experiences of the silent protest: implications for promoting healing and resilience’, Qualitative Health Research, vol. 26, no. 6, pp. 818-829, doi: 10.1177/1049732315573201.
Pavio, SC & Patterson, LA 1999, ‘Alliance development in therapy for resolving child abuse issues’, Psychotherapy, vol. 36, no. 4, 343-354, http://psycnet.apa.org/doi/10.1037/h0087843.
Pleck, JH 1995, ‘The gender role strain paradigm: an update’, in RF Levant & WS Pollack (eds), A new psychology of men, Basic Books, New York, pp. 11-32.
Rodgers, M, Meisel, Z, Wiebe, D, Crits-Christoph, P & Rhodes, KV 2016, ‘Wireless participant incentives using reloadable bank cards to increase clinical trial retention with abused women drinkers: a natural experiment’, Journal of Interpersonal Violence, pp. 1-23, doi: 10.1177/0886260516662849.
Romano, E & De Luca RV 2006, ‘Evaluation of a treatment program for sexually abused adult males’, Journal of Family Violence, vol. 21, no. 1, pp. 75-88, https://doi.org/10.1007/s10896-005-9006-y.
Ryan, M, Nitsun, M, Gilbert, L & Mason H 2005, ‘A prospective study of the effectiveness of group and individual psychotherapy for CSA survivors’, Psychology and Psychotherapy: Theory, Research and Practice, vol. 78, no. 4, pp. 465-480. doi: 10.1348/147608305X42226.
SACC Guideline 2011, Sexual Assault Crisis Centre of Essex County: west region male service guidelines, Windsor.
Sharpe, H, Selley, C, Low, L & Hall, Z 2001, ‘Group analytic therapy for male survivors of childhood sexual abuse’, Group Analysis, vol. 34, no. 2, pp. 195-209, https://doi.org/10.1177%2F05333160122077802.
Sherman, MD, Sautter, F, Jackson, MH, Lyons, JA & Han, X 2006, ‘Domestic violence in veterans with postraumatic stress disorder who seek couples therapy’, Journal of Marital and Family Therapy, vol. 32, no. 4, pp. 479-490. doi: 10.1111/j.1752-0606.2006.tb01622.x.
Smith, P, Yule, W & Perrin, S 2007, ‘Cognitive-behavioural therapy for PTSD in children and adolescents: a preliminary randomized controlled trial’, Journal of the American Academy of Child and Adolescent Psychiatry, vol. 46, pp. 1051-1061, https://doi.org/10.1097/CHI.0b013e318067e288.
Stalker, CA & Fry, R 1999, ‘A comparison of short-term group and individual therapy for sexually abused women’, Canadian Journal of Psychiatry, vol. 44, no. 2, pp. 168-174, doi: 10.1177/070674379904400208.
Steel, J, Sanna, L & Hammond, B 2004, ‘Psychological sequelae of childhood sexual abuse: abuse-related characteristics, coping strategies, and attributional style’, Child Abuse and Neglect, vol. 28, no. 7, pp. 785-801, doi: 10.1016/j.chiabu.2003.12.004.
Stoltenborgh, M, Van Ijzendoorn, MH, Euser, EM & Bakermans-Kranenburg, MJ 2011, ‘A global perspective on child sexual abuse: meta-analysis of prevalence around the world’, Child Maltreatment, vol. 16, pp. 79–101, doi: 10.1177/1077559511403920.
Tourigny, M & Baril, K 2011, ‘Les agressions sexuelles durant l’enfance, ampleur et facteur de risque’, in M Hébert, M Cyr & M Tourigny (eds), L’agression sexuelle envers les enfants, tome 1, Presses de l’Université du Québec, Montreal.
Trocmé, N, Fallon, B, MacLaurin, B, Daciuk, J, Felstiner, C, Black, T, Tonmyr, L, Blackstock, C, Barter, K, Turcotte, D & Cloutier, R 2005, Canadian incidence study of reported child abuse and neglect - 2003: major ﬁndings, viewed 20 November 2018, <http://cwrp.ca/sites/default/files/publications/en/cis2003.pdf>.
Trask, EV, Walsh, K & DiLillo, D 2011, ‘Treatment effects for common outcomes of child sexual abuse: a current meta-analysis’, Aggressive Violent Behavior, vol. 16, no. 1, pp. 6–19. doi: 10.1016/j.avb.2010.10.001.
Weiss, DS & Marmar, CR 1997, ‘The impact of event scale-revised’, in JP Wilson & TM Keane (eds), Assessing psychological trauma and PTSD, Guilford Press, New York, pp. 399-411.
Weiss, DS 2004, ‘The impact of event scale-revised’, in JP Wilson & TM Keane (eds), Assessing psychological trauma and PTSD, 2nd edn, Guilford Press, New York, pp. 168-189.
Westbury, E & Tutty, LM 1999, ‘The efficacy of group treatment for survivors of childhood abuse’, Child Abuse and Neglect, vol. 23, no. 1, pp. 31-44, doi: 10.1016/S0145-2134(98)00109-4.
Wilen, JS 2014, A systematic review and network meta-analysis of psychosocial interventions for interventions for adults who were sexually abused as children, Doctor of Philosophy Bryn Mawr College, Lower Merion.
Wu, KK & Chan, KS 2003, ‘The development of the Chinese version of Impact of Event Scale – Revised (CIES-R)’, Social Psychiatry and Epidemiology, vol. 38, no. 2, pp. 94–98, https://doi.org/10.1007/s00127-003-0611-x.
Yegidis, BL, Weinbach, RW & Myers, LL 2012, Research methods for social workers, 7th edn, Pearson Education, London.