OBJECTIVE
To systematically assess the evidence for an association between sexual abuse and
a lifetime diagnosis of psychiatric disorders.
PATIENTS AND METHODS
We performed a comprehensive search (from January 1980-December 2008, all age groups,
any language, any population) of 9 databases: MEDLINE, EMBASE, CINAHL, Current Contents,
PsycINFO, ACP Journal Club, CCTR, CDSR, and DARE. Controlled vocabulary supplemented
with keywords was used to define the concept areas of sexual abuse and psychiatric
disorders and was limited to epidemiological studies. Six independent reviewers extracted
descriptive, quality, and outcome data from eligible longitudinal studies. Odds ratios
(ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects
model. The I2 statistic was used to assess heterogeneity.
RESULTS
The search yielded 37 eligible studies, 17 case-control and 20 cohort, with 3,162,318
participants. There was a statistically significant association between sexual abuse
and a lifetime diagnosis of anxiety disorder (OR, 3.09; 95% CI, 2.43-3.94), depression
(OR, 2.66; 95% CI, 2.14-3.30), eating disorders (OR, 2.72; 95% CI, 2.04-3.63), posttraumatic
stress disorder (OR, 2.34; 95% CI, 1.59-3.43), sleep disorders (OR, 16.17; 95% CI,
2.06-126.76), and suicide attempts (OR, 4.14; 95% CI, 2.98-5.76). Associations persisted
regardless of the victim's sex or the age at which abuse occurred. There was no statistically
significant association between sexual abuse and a diagnosis of schizophrenia or somatoform
disorders. No longitudinal studies that assessed bipolar disorder or obsessive-compulsive
disorder were found. Associations between sexual abuse and depression, eating disorders,
and posttraumatic stress disorder were strengthened by a history of rape.
CONCLUSION
A history of sexual abuse is associated with an increased risk of a lifetime diagnosis
of multiple psychiatric disorders.
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