Exhibit B¶
Facilitators and Barriers to Child Sexual Abuse (CSA) Disclosures: A Research Update (2000-20 I 6)¶
TRAUMA. VIOLENCE & ABUSE 2019, Vol. 20(2) 260-283 C The Author(s) 2017 Artock roust guidelines: sacepub comlioumalvptimoskin DOI, 10117711124838017697312 nals sagepuboornlhomakva OSAGE¶
Ramona Alaggial , Delphine Collin-Vezina2, and Rusan Lateefl¶
Abstract¶
Identifying and understanding factors that promote or inhibit child sexual abuse (CSA) disclosures has the potential to facilitate earlier disclosures, assist survivors to receive services without delay, and prevent further sexual victimization. Timely access to therapeutic services can mitigate risk to the mental health of survivors of all ages. This review of the research focuses on CSA disdosures with children, youth, and adults across the life course. Using Kiteley and Stogdon’s literature review framework. 33 studies since 2000 were identified and analyzed to extrapolate the most convincing findings to be considered for practice and future research. The centering question asked: What is the state of CSA disclosure research and what can be learned to apply to practice and future research? Using Braun and Clarke’s guidelines for thematic analysis. five themes emerged: (I) Disclosure is an iterative, interactive process rather than a discrete event best done within a relational context; (2) contemporary disclosure models reflect a social—ecological, person-in-environment orientation for understanding the complex interplay of individual, familial, contextual, and cultural factors involved in CA disclosure; (3) age and gender significantly influence disclosure; (4) there is a lack of a life-course perspective; and (5) barriers to disclosure continue to outweigh facilitators. Although solid strides have been made in understanding CSA disclosures, the current state of knowledge does not fully capture a cohesive picture of dis. dosure processes and pathways over the life course. More research is needed on environmental. contextual, and cultural factors. Barriers continue to be identified more frequently than facilitators, although dialogical forums are emerging as important facilitators of CSA disclosure. Implications for practice in facilitating CSA disclosures are discussed with recommendations for future research.¶
Keywords¶
sexual abuse, child abuse, cultural contexts¶
Introduction¶
Timely access to supportive and therapeutic resources for child sexual abuse (CSA) survivors can mitigate risk to the health and mental health well-being of children, youth, and adults. Identifying and understanding factors that promote or inhibit CSA disclosures have the potential to facilitate earlier disclosures, assist survivors to receive services without delay, and potentially prevent further sexual victimization. Increased knowledge on both the factors and the processes involved in CSA disclosures is timely when research continues to show high rates of delayed disclosures (Collin-VEzina, Sablonni, Palmer, & Milne, 2015; Crisma, Bascelli, Paci, & Romito, 2004; Easton, 2013; Goodman-Brown, Edelstein, Goodman, Jones, & Gordon, 2003; Hershkowitz, Lanes, & Lamb; 2007; Jonzon & Lindblad, 2004; McElvaney, 2015; Smith et al., 2000).¶
Incidence studies in the United States and Canada report decreasing CSA rates (Fallon et al., 2015; Finkelhor, Shattuck, Turner, & Hamby, 2014; Trocme et al., 2005, 2008), while at¶
the same time global trends from systematic reviews and metaanalyses have found concerning rates of CSA, with averages of 18-20% for females and of 8-10% for males (Pereda, Guilera, Fours, & Gomez-Benito, 2009). The highest rates found for girls is in Australia (21.5%) and for boys in Africa (19.3%), with the lowest rates for both girls (11.3%) and boys (4.1%) reported in Asia (Stoltenborgh, van Uzendoorn, Euser, & Bakermans-Kranenburg, 20 I 1). These findings point to the incongruence between the low number of official reports of¶
Corresponding Author:¶
I Factor-Inwentash Faculty of Social Work. University of Toronto. Toronto. Ontario. Canada¶
2Centre for Research on Children and Families. School of Social Work, McGill University. Montreal. Qubec. Canada¶
Ramona Alaggia. Factor-Inwentash Chair in Children’s Mental Health. Factor-Inwentash Faculty of Social Work. University of Toronto. 246 Moor St West. Toronto, Ontatio, Canada M4K I W I. ramonaalaggiaeutorortoca¶
CSA to authorities and the high rates reported in prevalence studies. For example, a meta-analysis conducted by Stoltenborgh, van LIzendoom, Euser, and Bakermans-Kranenburg (2011) combining estimations of CSA in 217 studies published between 1980 and 2008 revealed rates of CSA to be more than 30 times greater in studies relying on self-reports (127 in 1,000) than in official report inquiries, such as those based on data from child protection services and the police (4 in 1,000) (Julian, Cotter, & Perreault, 2014; Statistics Canada 2013). In other words, while 1 out of 8 people retrospectively report having experienced CSA, official incidence estimates indicate only 1 per 250 children. In a survey of Swiss child services, Maier, Mohler-Kuo, Landholt, Schnyder, and Jud (2013) further found 2.68 cases per 1,000 of CSA disclosures, while in a recent comprehensive review McElvaney (2015) details the high prevalence of delayed, partial, and nondisclosures in childhood indicating a persistent trend toward withholding CSA disclosure.¶
It is our view that incidence statistics are likely an underestimation of CSA disclosures, and this drives the rationale for the current review. Given the persistence of delayed disclosures with research showing a large number of survivors only disclosing in adulthood (Collin-Vezina et al., 2015; Easton, 2013; Hunter, 2011; McElvaney, 2015; Smith et al., 2000), these issues should be a concern for practitioners, policy makers, and the general public (McElvaney, 2015). The longer disclosures are delayed, the longer individuals potentially live with serious negative effects and mental health problems such as depression, anxiety, trauma disorders, and addictions, without receiving necessary treatment. This also increases the likelihood of more victims falling prey to undetected offenders. Learning more about CSA disclosure factors and processes to help advance our knowledge base may help professionals to facilitate earlier disclosures.¶
Previous literature reviews examining factors influencing CSA disclosure have served the field well but are no longer current. Important contributions on CSA disclosures include Paine and Hansen’s (2002) original review covering the literature largely from the premillennium era, followed by London, Bruck, Ceci, and Shuman’s (2005) subsequent review, which may not have captured publications affected by “lag to print” delays so common in peer-reviewed journals. These reviews are now dated and therefore do not take into account the plethora of research that has been accumulated over the past 15 years. Other recent reviews exist but with distinct contributions on the dialogical relational processes of disclosure (Reitsema & Grietens, 2015), CSA disclosures in adulthood (Tener & Murphy, 2015), and delayed disclosures in childhood (McElvaney, 20I5). This literature review differs by focusing on CSA disclosures in children, youth, and adults from childhood and into adulthood—over the life course.¶
Method¶
Kiteley and Stogdon’s (2014) systematic review framework was utilized to establish what has been investigated in CSA¶
disclosure research, through various mixed methods, to highlight the most convincing findings that should be considered for future research, practice, and program planning. This review centered on the question: What is the state of CSA disclosure research and what can be learned to apply to future research and practice? By way of clarification, the term systematic refers to a methodologically sound strategy for searching literature on studies for knowledge construction, in this case the CSA disclosure literature, rather than intervention studies. The years spanned for searching the literature were 2000-2016, building on previous reviews without a great deal of overlap. Retrieval of relevant research was done by searching international electronic databases: PsycINFO, PsycARTICLES, Educational Resources Information Center, Canadian Research Index, International Bibliography of the Social Sciences, Published International Literature on Traumatic Stress, Sociological Abstracts, Social Service Abstracts, and Applied Social Science Index and Abstracts. This review searched peerreviewed studies. A search of the gray literature (unpublished literature such as internal agency documents, government reports, etc.) was beyond the scope of this review because unpublished studies are not subjected to a peer-review process. Keyword search terms used were child sexual abuse, childhood sexual abuse, disclosure, and telling.¶
A search of the 9 databases produced 322 peer-reviewed articles. Selected search terms yielded 200 English publications, I French study, and 1 Portuguese review. The search was further refined by excluding studies focusing on forensic investigations, as these studies constitute a specialized legal focus on interview approaches and techniques. As well, papers that focused exclusively on rates and responses to CSA disclosure were excluded, as these are substantial areas unto themselves, exceeding the aims of the review question. Review articles were also excluded. Once the exclusion criteria were applied, the search results yielded 33 articles. These studies were subjected to a thematic analysis as described by Braun and Clarke (2006). This entailed (I) multiple readings by the three authors; (2) identifying patterns across studies by coding and charting specific features; (3) examining disclosure definitions used, sample characteristics, and measures utilized; and (4) major findings were extrapolated. Reading of the articles was initially conducted by the authors to identify general trends in a first level of analyses and then subsequently to identify themes through a deeper second-level analyses. A table of studies was generated and was continuously revised as the selection of studies was refined (see Table 1).¶
Key Findings¶
First-level analysis of the studies identified key study characteristics. Trends emerged around definitions of CSA disclosure, study designs, and sampling issues. First, in regard to definitions, the term “telling” is most frequently used in place of the term disclosure. In the absence of standardized questionnaires or disclosure instruments, telling emerges as a practical term more readily understood by study participants. Several¶
| Study | Purpose | Des gn | Samp e | F nd ngs | Summary |
|---|---|---|---|---|---|
| Gagner and Co n Vez na (2016) | To exp ore d sc osure processes for ma e A v ct ms of C | methodo ogy used to ntery ew ma e CSA sury vors. The Long Intery ew Method (LIM) gu ded data Phenomeno og ca co ea on and ana yses. | Purpos ve samp rig 17 men ranged n age strategy was used — average age 47. from 19 to 67 | d sc osure w th try ng to forget. Break ng The major ty of the men n the study wa ted forms of med a on d sc osure. Important d sc osure a ong w th the a d of var ous unt adu thood to d sc ose the r abuse. w th negat ve stereotypes contr but ng to the r de ayed d sc osures. Negat ve med a was so at on was c ted as a mot vator to stereotyp ng of ma es. sexua ty. and stereotypes contr buted to de ayed contextua ssues such as negat ve v ct ms were noted. Soc a | part c pat ng n the study. Member the part c pants to check themes. check ng cou d not be done w th h gh eve of r gor n estab sh ng trustworth ness of the data and A part c pants had d sc osed and qua tat ve nqu ry. Otherw se, ana ys s. Retrospect ve study but surf c ent s ze for a rece ved sery ces before ssues mp y reca cou d Sma |
| Braze ton (2015) | traumat c exper ences To exp ore the mean rig women make of the r they d sc osed across w th CSA and how Afr can Amer can the fe course | co ea on and am ys s. (storyboard) for data Co ect ve case study narrat ve wad t on des gn w th us ng ntery ew ng Qua tat ve | Purpos ye. snowba ng between 40 and 63 17 Afr can Amer can women n m d- fe who exper enced ntrafam a CSA_ strategy | and 9. No one ever ta ked to them about breakdown and remova , not want ng to CSA onset was arge y between the ages 5 d sm ssed d sc osures dent f ed over the fe course. A 17 part c pants dent f ed retr but on by tam y members f they tarn sh the fam y’s name, and fear of sex, so they d dn’t have anguage to strength throughout the fe course sp r tua ty as a pr mary source of seen as a fac tator of d sc osures d sc ose. Barr en: fear of fam y d sc osed. Pattern of st fed and | for a qua tat ve nqu ry. Important Use of a fe-course perspect ye as to ater years of fe that shou d be ssues. understand ng CSA n the m dd e exc us ye y on Afr can Amer can but stiff cent s ze cu tura and contextua ssues Retrospect ye study that may have been affected by reca One of few stud es to focus were brought forward. cons dered n further ens for women. Sma a theoret ca |
| Co n-Vez na, Sab onn . Pa mer, and M ne (20 I 5) | To prov de a mapp ng of ens from a samp e of through an eco og ca CSA adu t sury von. factors that prevent CSA d sc osures | Qua at ve des gn us ng LIM. | dent f ed as fema e and 67 ma e and fema e CSA ranges from 19 to 69 adu t sury vors (76% Purpos ve samp ng 24% as ma e). Age years (M = 44.9). strategy | mmature deve opment at t me of abuse: m b am ng, Three broad categor es were dent fed as —v o ence wor d sery ces ava ab e. and cu ture or t me dynam a. awareness of the mpact of and dysfuna on n the fam y, power barr en to CSA d sc osure: Barr ers mechan sms to protect onese f. and abe ng, taboo of sexua ty, ack of to ng, and frag e soc a network; barr en n re at on to the soc a barr en n re at on to others from w th n- nterna zed v a | Retrospect ye aspect of the study H gh eve of rgor n estab sh ng before part c pat ng n the study. d sc osed the r CSA exper ences trustworth ness of the data and pan c pants had d sc osed and Ha f of the part c pants had not rece ved counse ng at some ssues. A before the age of 19. mp y reca nvest gat ons ana ys s cou d |
| Wort ey Lec erc and (20 I 5) | factors that fac tate CSA d sc osures nvest gated the Study object yes | exam ne pred ctors of Adu t ma e ch d sexua offenders were ntery ewed to | sexua offense aga nst a 369 adu t ma es who had ch d aged between I been cony cted of a | v ct m was not v ng w th die offender at v ct m: f penetrat on had occurred, f the v ct m was re aced to the offender, f the D sc osure ncreased w th the age of the per od. | (continued) se (-reports cou d be subject to Offender generated data through m n m sat on or exaggerat ons. — cogn t ve d stort ons |
rig Table I. Ch d Sexua Abuse (CSA) D sc osure Stud es: 2000-2016.¶
Table I. (cont nued)¶
| Study | Purpose | Des gn | Samp e | F nd rags | Summary |
|---|---|---|---|---|---|
| McE vaney and Cu hane (2015) | teas b ty of us ng ch d assess f these reports assessments as data CSA d sc osure. To prov de substant ye data on d sc osures sources of nforma To nvest gate the | seen for assessment n F e reports of ch dren ntery ews based on a ch d sexua abuse un t n a ch dren’s v ct m d sc osure. Sem structured quest onna re. were rev ewed the QID hosp ta | Parents were asked to ch d’s f e rev ewed for Wh te. comp eted on 39 f es assessed were 12-18 consent to have the r uneducated, a most cod ng framework. before the r arrest Content ana ys s was ma es) based on a the study. V a ms (32 fema es and 7 and I7 years o d. ha f unemp oyed Major ty were years of age | res sted dur ng the offense. Ma e v a ms themes were dent fed as nf uenc ng the d sc osure process: (I) fee ng d stressed. se f. Add t ona themes of be ng be eyed. (43%) and peers (33%) f rst_ Three major ke y to d sc ose (2) opportun ty to te . and (3) fears for m Major ty of ch dren to d the r mothers shame/se f-b ame. and peer nf uence the t me of the abuse, or f the v a and v a ms from dysfuna ona backgrounds were ess were a so dent fed | vu nerab ty of v ct ms n re at on mportant toner bute to a arge mu t s te study n Ire and. Serves as an Penpect ves of offenders on but w mportant exp oratory p of br ng ng forward d sc osure themes for cons dent on to d sc osure cou d be nformat on to nform The samp e s ze s sma ntervent ons |
| Dumont, Messerschm tt Rey-Sa mon (2014) V a, Bohu. and | re at onsh p between m, espec a y the perpetrator and a, mpact Th s study a med to exp ore how the CSA d sc osure ntrafam a or whether these re at ons are extrafam the v ct | seen for assessment n F e reports of ch dren a ch d sexua abuse un t n a ch dren’s were rev ewed hasp ta | 78.2% fema e v a ms. preva ent age range). 41.8% aged between abused by a fam y 220 m nor v a rns 14 and 18 (most and 48.2% were member | days after, most often to the r mother or 80% of the v a ms revea the facts a few D sc osure processes were more cone ex the d sc osures done at schoo): on the comm tted by ntrafam a perpetrator nd v dua s outs de the fam y (78.6% of contrary. extrafam a d sc osures take p ace more spontaneous y and qu ck y: seven years after, and most often to 60% of the v a ms revea the facts when t concerned sexua abuse peers | be d sc osed prompt y and w th n ke y to rec p ent of d sc osure. w th perpetrator has a s gn f cant mpact on both t m ng and ntrafam a abuses ess The re at onsh p w th the the tam y system |
| Easton. Sa tzman. and W 5 (2014) | d sc osure w th ma e Study focus was on barr en to CSA dent f cat on of sury von | conducted a secondary We -Be ng men w th se (-reported Us ng qua tat ve content CSA h stor es w th an survey data. the 2010 Survey. that nc uded open-ended tem on ana ys s, researchers d sc osure barr ers ana ys s of on ne Heath and | h stor es comp eted an respondents reported range of 18-84 years. anonymous, Internet- c ergy-re ated abuse. organ zat ons. Age respondents were 460 men w th CSA Recta ted from Two th rds of based survey. Major ty of sury yore Wh te | 3 years. Ten years o d was average age of resources; (2) nterpersona : m strust of months to 3 years. and 34.3% more than others, fear of be ng abe ed “gay,” safety nto: 30.2% ess than 6 months. 32.3% 6 Vast major ty of part c pants (94.6%) were were c ass fed nto three doma ns: (I) CSA onset Ten categor es of barr en see ng the exper ence as sexua abuse. Durst on of sexua abuse broke down and protect on ssues, past responses: and (3) persona: ntema emot ons. m ted sexua y abused by another ma e. soc opo t ca: mascu n ty. and sexua or enat on. | argest qua tat ve data set to have wh ch m ght present a un que set based on race or ethn c ty were m ted n terms of the ow At t me of the study. th s was the percept ons of barr en to CSA d sc osure. Because the samp e not d scerned. The major ty of been ana yzed w th an exp c t m nor t es focus on adu t ma e sury vors’ abuse reported was by c ergy (9.3%). d sc osure d fferences of barr ers to d sc osure percentage of rac a was |
| (continued) |
Pt’ Table I. (cont nued)¶
| Study | Purpose | Des gn | Samp e | F nd ngs | Summary |
|---|---|---|---|---|---|
| Easton (2013) | re at onsh ps between age. A so. to exp ore d fferences based on d sc osure processes d sc osure attr butes approach exam n ng Study purpose was to descr be ma e CSA and men’s menta us ng a fe span hea th | Genera Assessment of Genera Menta Heath 2010. Measures used: Quest ons re ated to anonymous, Internet- Cross-sect ona survey based survey dur ng CSA d sc osure and D stress Sca e and part c pants were Ind v dua Needs. des grt.E gbe supports were comp eted an screened and nc uded | Mean age for onset of nat ona organ zat ons 487 men from three CSA was 10.3 years Purpos ve samp ng of range: 19-84 years. awareness of CSA devoted to ra s ng among men. Age | menta hea th profess ona (20%): 42% of protect ve responses and the he pfu ness mportance member were both re ated to de ays n responses caused most menta d stress. m xed. De ays n te ng were s gn f cant hea th profess ona. However. unhe pfu d sc osure. Most part c pants who to d part c pants f rst to d about the sexua abuse to a spouse/partner (27%) or a part c pants reported that the r most of responses across the fe span was O der age and be ng abused by a fam y more of a fe-course perspect ve be he pfu d scuss on was w th a menta C n ca recommendat ons nc uded someone dur ng ch dhood d d not rece ve emot ona y support ve or adopted. understand ng mpact of per ods oft me (over 20 years). of expand ng networks for ma e Approx mate y one ha f of the unhe pfu responses and the | groups and requ red prof c ency n certa n cu tura groups. However. access to a predom nant y h dden an emphas son a fe-course focus have e m nated men n ower SES recommendat ons are made w th access to Internet wh ch wou d awareness ra s ng organ zat ons Purpos ye samp ng of men from m nate may have attracted part cu ar part c pants who had a ready popu at on. Important c n ca d sc osed and rece ved he p. the samp ng strategy ga ned Part c pants needed to have Eng sh wh ch wou d e |
| McE vaney. Greene. and Hogan (2012) | deve op theory of how Qua tat ve study asked exper ences. Parents the centre research of the r quest on: “How do were ntery ewed. Object ve was to CSA d sc osure ch dren te ?“ ch dren te | cod ng was conducted conducted. L ne-by ne open and ax a Intery ews were Grounded theory method study. on verbat m transcr pts | ages of 8 and 18. M xed extrafam a CSA, and boys: age range: 8-18 16 g r s and 6 years: 22 ntery ewed n ton between the endur ng ntrafam a two endured both Samp e of 22 young samp e of some CSA, some forms peop | ref ect ng a conf ct between the w sh to exper ence of a “pressure cooker effect” te and the w sh to keep the secret; and secret (I) the act ve w thho d ng of the e even categor es that were deve oped re at onsh p. These were der ved from secret on the part of the ch d; (2) the mode was deve oped that conceptua zes the process of CSA d sc osure as one of conta n ng the (3) the conf d ng tse f wh ch often occurs n the context of a trusted through open and ax a cod ng A theoret ca sury von | be made to the age range samp ed ndependent y coded. Very young Transferab ty of f nd ngs can on y Modest but suff c ent samp e for an r gor. A subsamp e of random y ch dren and young adu is were exp oratory qua tat ve nqu ry. H gh eve of trustworth ness not captured n th s samp e. n the context of Ire and se ected transcr pts was |
| Moh er-Kuo, Schnyder, and Lando t (20 I 2) Schonbucher, Ma er, | who had exper enced ado escents from the genera popu at on d sc osed, who d d CSA. How many process of CSA To nvest gate the d sc osure w th | Standard zed quest ons adm n stered on fam y qua tat ve ntery ews. through face-to-face and measures were soc odemograph c Data co ect on was s tuat on. | and 3 boys. Age range: 26 sexua y v ct m zed Conven ence samp e of I5—I8 years. On ne ado escents. 23 g r s f yen were used to advert cements and recru t youth from | person. In most cases, rec p ents of both abuse to a parent. Part c pants reported mmed ate and de ayed d sc osure were mmed ate y d sc osed CSA to another re uctance to d sc ose to parents so as part c pants had never d sc osed the to peers. More than one th rd of Less than one th rd of part c pants | d sc ose r ght away. Strengthen ng (continued) parent—ch d re at onsh ps may be to ncrease d sc osure to parents. mportant ways found a common trend n other Two th rds of the samp e d d not D sc osure to peers has been one of the most |
| Table I. (cant nued) | |||||
|---|---|---|---|---|---|
| Study | Purpose | Des gn | Samp e | F nd ngs | Summary |
| Hunter (20 I I ) | A m of th s study was to understand ng of CSA mot yes for d Sc os ng they d sc ose to, and what were the r deve op a fu er d sc osures | Assau t Modu e Rosentha and F scher— v ct m sat on. genera . methodo ogy. Face-to were ana yzed us ng Quest onna re was Rosentha ‘s (2004) and menta hea th. part c pants. Data ntery ews were conducted w th Narrat ve nqu ry of the Juven e V ct m sat on face n-depth data, sexua method. Sexua used | and 9 men. Part c pants were sexua y abused Purpos ye samp ng was at IS years or under part c pants aged 25- 70 years: 13 women w th someone over counse ng sery ces emp oyed. Samp e cons sted of 22 commun ty and the age of It | together. H gher eves of reported gu t conceptua zed and v ewed as a comp ex were re ated to extrafam a CSA, s ng e ver fy ng behav on nd rect attempts to through subthemes. Te ng as a ch d and categor es. Themat c ana ys s supported not to burden them. Ear er d sc osures occurrence CSA, age of v ct m at abuse On y 5 out of 22 part c pants to d anyone about the r ear y sexua exper ences as as an adu t was further expanded upon were the man nh b ton to d sc osure. d sc osures. Peers were v ewed by th s ch dren. Fear, shame, and se f-b ame and shame were re ated to de ayed v ng samp e as more re ab e con( darts These factors are further dem ed us ng A agg a’s (2004) framework te and purposefu d sc osure as that CSA d sc osure shou d be onset, and parents who were | adu thood. These f nd ngs support De ayed d sc osure was common n We -des gned d sc osure but a so h gh ghts the mportance of fe stage. Modest study w th dem ed ana ys s for but suff c ent samp e s ze for a th s qua tat ve samp e. Most part c pants d d not make a A agg a’s (2004) mode of research and bears more transferab ty off nd ngs se ect ve d sc osure unt qua tat ve nqu ry. exam nat on |
| Schaeffer, Leventha , and Asnes (2011) | ch d’s CSA d sc osure; about the process of a to te : and (3) descr be to te about or caused process that ed them Th s study a med to: (I) dent fy that ed them factors that ch dren d scuff them to de ay CSA add d rect nqu ry (2) determ ne f ch dren w d sc osure | Study sought to f nd out f extracted, transcr bed, ch dren’s reasons for te ng or wa t ng was asked to ncorporate ntery ews. Forens c d sc osure cou d be context of forens c method of ana ys s and ana yzed us ng ntery ewers were ntery ew protoco Intery ew content grounded theory process flues of ex st ng forens c quest ons about ”te ng” nto an dent f ed n the re ated to the | ms aged 3-18 over nc uded ch dren who 74% were ferna e and a -year per od were ntery ewed at a ch d 51% were Caucas an 191 ntery ews of CSA refers. reasons for about CSA pr or to te ng or wa t ng to te , and those who ch dren who were used for the study. sexua abuse c n c. made a statement Part c pants were Inc us on cr ter a spoke Eng sit. v ct | d rect ev dente of abuse (e.g., the ch d’s nto f ve groups: get n troub e f she or he to 4 (2) fears wou d happen f she or he to d), (3) ack (e.g the ch d fa ed to recogn ze abus ye (e.g the ch d was to d she or he wou d (e.g the ch d was afra d someth ng bad the ch d thought the perpetrator was a re at onsh p w th the perpetrator (e.g. were c ass fed nto three doma ns: (1) Reasons the ch dren dent fed for te ng quest oned): and (3) d sc osure due to abuse was w tnessed). The barr ers to d sc osure as a resu t of nterna st mu of opportun ty (e.g., the ch d fe t the presented), (4) ack of understand ng (I) threats made by the perpetrator (e.g. the ch d had n ghtmares): (2) behav or as unacceptab e), and (5) d sc osure fac tated by outs de opportun ty to d sc ose never of uences (e.g. the ch d was d sc osure dent f ed fe and fe ong process fr end) | An nnovat ve study to try to assess A. nvest gat ye ntery ews f nd ngs support ng other study number of ntery ews. Dem ed can fac tate d sc osures of C Data were based on a arge f nd ngs on CSA d sc osure ana ys s produced dem ed f forma |
(continued)¶
| cr. P I-, | Table I. (coin nued) | |||||
|---|---|---|---|---|---|---|
| Study | Purpose | Des gn | Samp e | F nd ngs | Summary | |
| A agg a (2010) | mped ng or promot ng Overarch ng research nf uences mpede or promote env ronmenta . and The study a med to CSA d sc osures. CSA d sc osures. quest on: What dent fy factors nterpersona . contextua nd v dua, | to ntery ew adu t CSA retrospect ve accounts d sc osure exper ences of CSA d sc osure and done through a soc a — Themat c ana ys s was des gn, LIM, was used sury von about the r mean ng-mak ng of these exper ences. phenomeno og ca ens. to prov de A qua tat ve eco og ca | samp ng was a so used A were mean age of 40.1 years. o d. 36% of the samp e ntery ewed: 36% men range of 18-65 w th a and 64% women. Age to recru t more ma e Average age of abuse Purpos ye samp ng was onset was 5.3 years sury von. 40 adu t emp oyed. Snowba Wh te. soc oeconom c sury von of C backgrounds was non- D verse | nterest from ne ghbors and teachers not unheard as k ds, gender soc a zat on for some bear ng on the r ab ty to te . and parent’s react ons. Purposefu d sc osure s h gher than reported n other stud es dysfunct ona commun cat on. and soc a ma es. and cu tura an tudes of uenc ng messages and soc eta an tudes. fee ng gender ro es w th dom nat ng fathers, chaos and aggress on. other forms of happen ng, persona ty tra is a so had nd v dua and deve opmenta factors, deve opmenta factors as to whether cu tura and soc eta an tudes, med a because of the samp ng attempts to pursu ng troub ng behav or; and (4) commun ty context. that s. ack of character st cs such as rgdy fxed ant c pat ng not be ng be eyed; (2) nto four doma ns: (I) so at on; (3) ne ghborhood and ch d abuse, domest c v o ence. they comprehended what was purposefu y ocate d sc osers d sc osure nh b ted by fam y Themes fe | approach that cou d be affected by The study presents a comprehens ve d sc osure n nd rett ways dur ng years and they had d dal ty w th soc a —eco og ca ana ys s to CSA mu t faceted of uences. Of note, abuse had occurred n preschoo dur ng ch dhood: 26% had not repressed the memory, or the 42% had d sc osed the abuse d sc osed because they had ch dhood. A retrospect ye d sc osure h gh ght ng the reca . The rema nder had attempted some form of ssues reca | |
| Fontes and P ummer (2010) | Th s exam nat on of CSA report ng. both n the affects processes of d sc osure exp ored CSA d sc osure and Un ted States and the ways cu ture nternat ona y | Us ng pub shed terature d sc osure quest on ng wthc nca data, th s cu tura y competent art c e conducted an ana ys s to prov de a framework for CSA | pub shed terature on d sc osure and cu ture that was tr angu ated wthc n ca case Data cons sted of mater a | CSA d sc osure are dent f ed n n-depth cons der ng d sc os ng or be ng asked to d sc ose. and not so e y n cases nwh ch ntery ew framework ntegrat ng cu tura Recommendat ons made nc ude factor n a cases n wh ch ch dren are ta ored to the ch d’s cu tura context. mportant cons dent on age and gender factors. ch dren are from not ceab e m nor ty Cu tura and structura factors affect ng ( I) d sc osure ntery ew ng shou d be (2) quest on ng shou d a so take nto groups. Presents a comprehens ye and (3) cu ture stands as an cons dent ons deta | ntery ew ng. Un que comb nat on mater a . Anecdota accounts may wthcn ca One of the few works that adds f nd ngs. Oven adds to an mpover shed area of CSA prec ude transferab ty of know edge to cu tun y d sc osure nformat on contextua d sc osure of teraturefnd ngs | |
| McConne . Tutty, and Fa rho m. (2009a) Ungar, Barter. | w th a nat ona sampe of youth focus ng on d sc osure strateg es Th s study exp ored | pan c pat on n abuse Forms were comp eted by youth fo ow ng prevent on | from a nat ona sampe Exam nat on of resu is forms where youth of 1,621 eva uat on | to s gna the abuse to others; not ta k ng Youth who have been abused or w tnesses strateg es: us ng se f-harm ng behav on to abuse emp oy f ve d sc osure | s an nteract ye ongo ng process. Th s study h gh ghts that d sc osure F nd ngs end support to stud es that have dent f ed s mar y | |
| (continued) |
| IS (37%), 16-17 (25%). anonymous y d sc osed 18 and o der (4%), and 1,099 eva uat on forms Red Cross RespectED Respondent’s ages: 13 and under (27%). 14- comp eted fo ow ng v o ence prevent on abuse exper ences. Purposefu samp e of de vered between 2000 and 2003 unknown (7%) programm rig Exp oratory des gn w th a Red Cross RespectED 2000 and 2003. Forms A ser es of focus groups prevent on programs: ( I) It’s not your fau t the workshops were forms were ana yzed Canad an Red Cross comp Ned fo ow ng of anonymous abuse d sc osures by youth m ng by the and observat ons of and (2) What’s ove samp es. Qua tat ye v o ence prevent on phys ca . f nd ngs. Eva uat on from two v o ence de vered between pan c pants of neg nonrepresentat ve got to do w th It? contextua ze the and sexua abuse. eva uat on forms ana ys s of 1,099 programm ng (RespectED). used to he p emot ona progra exper ences? (3) What part c paced nvoence abuse among Canad an h dden exper ences of d sc osure barr en do programm ng. One of was to document not the goa s of the study Who do they What part c pat on n abuse prevent on programs exper ences of abuse toward d sc osure of Canad an youth who prey ous y dent f ed d sc osure patterns? express the r abuse and youth att tudes are young peop es nat ona samp e of abuse exper ences Th s study exp ored have on youth to (I) What are the youth? (2) What abuse d sc osure strateg es w th a youth face? (4) mpact does prevent on and (5) to ? Ungar, Tutty. McConne . Barter, and Fa rho m (20096) | Des gn Purpose | Samp e | F nd ngs | Summary |
|---|---|---|---|---|
| quarters of fema es prey ous y d sc osed: educators, and careg vers. About three Patterns of ncrementa y char ng abuse regard ng consequences to d sc osure. workers and po ce). nteract ye process, w th expectat ons seek ng he p from peers; seek ng he p seek ng he p from mandated sery ce from nforma adu t supports: and ntrus ve ntervent ons by others; exper ences are shaped by young at a about the abuse to prevent peop e’s nteract ons w di peers, s gn f cant y ess ma es d sc osed Resu is suggest d sc osure s an prov den (soc a | Garde (2005). Th s m xed samp e —not in ted to CSA such as those deta ed by A agg a nteract ye modes of d sc osure (2004) and Sta er and Ne son- d fferent forms of abuse and of youth who exper enced v o ence exposure were part c pants SW, / vors | |||
| groups were a so done program fac tators n deve oped for ana ys s contextua ssues and to synthes ze themes the nterpretat on of ntery ews and focus across data sources f nd ngs. A cod ng engage youth and Twenty-seven to understand structure was | profess ona s or the po ce. One th rd of member be ng most ke y to d sc ose to abuse to c’VVh e 1.099 eva uat ons w th F nd ngs suggest h gh rates of h dden abuse, Out of a 1.099 part c pants, 225 ma es and 779 fema es nd cated that they had been fema es nd cated that they had d sc osed abused. Out of those. 43 ma es and 180 the abuse. Of those who had d sc osed, report ng a d sc osure. 244 of the 1,099 profess ona s and the east. 5% percent nd v dua s they to d about the r abuse. most ke y to d sc ose sexua abuse to parents. and others. Part c pants were d sc osure statements were ana yzed. on y 22% made ment on of peop e to spec fed who they had d sc osed the parentsffam y. profess ona s. and the youth aged I4-15, v ct ms of phys ca youth who d sc osed abuse on the r each, were d rected toward fr ends, on y a port on of ma es and fema es w th ess than one quarter of youth D sc osure patterns vary w th boys, abuse, and those abused by a fan y po ce/courts. w th fewer choos ng eva uat on forms dent fed spec f c d sc osures were d rected toward fr ends. | the th ckness of the descr pt ons t peop es percept ons of d sc osure and observat ona data. The study can offer because most of the data w th trustworth ness of the data p cked up. Scope of the study s ana ys s ensured through use of m ted n exper ences. H gh eve of r gor youth focus groups. ntery ews. broad and approach s treat ve d fferences may not have been Innovat ve des gn of th s study prov des ns ght nto young are survey based. Reg ona resu is are somewhat |
Table I. (cont nucd)¶
(continued)¶
| ao | Study | Purpose | Des gn | Samp e | Fnd ngs | Summary |
|---|---|---|---|---|---|---|
| Pr cbc and Svcd n (2008) | patterns and exam ne nvest gate d sc osure exper ences of sexua rates and d sc osure samp e of ma e and fema e ado escents w th se (-reported nond sc osure n a Th s study a med to pred ctors of abuse | terns from the SCL-90 and 9 of 25 tems from that nc uded quest ons for g r s and boys were 65- tern quest onna re nc ud ng peer abuse), consensua sex. sexua or penetrat rig abuse, the Parenta Bond ng Instrument_ The data (noncontact, contact Part c pants competed nc uded 6 mod( ed sexua exp o at on. own sexua abus ve ana yzed separate y about background, d sc osure of CSA, abuse exper ences The quest onna re exper ences w th pornography and Ma e sun von of C behav or. sexua att tudes. and | boys). The mean age of 1,962 part c pants who 18.15 years. Th s study The samp e cons sted of (2,324 g r s and 2,0 I 5 used a subsamp e of d sc osure quest ons the part c pants was students n Sweden reported CSA and 4,339 h gh schoo who answered | s b ng. G r s were ess ke y to d sc ose f There were h gher rates of d sc osure to penetrat on) for g r s. but ower rates for d sc ose f a fam y member abused them, fema es spec fed who they d sc osed to had d sc osed to profess ona s. and even they were study ng a vocat ona program A perce ved the r menta heath as poorer compared boys The more severe the sexua abuse key to % (g r s) and 69% abuse w th or w thout penetrat on. ess had ta ked to the r mother, father. or a often to a fr end of the r own age. Few member, or f they had perce ved the r w th more severe abuse fewer had reported to the author t es. Of the samp e, 1.505 g r s (65%) and 457 symptoms on the Mena Heath Sca e key both g r s and boys (boys). G r s and boys d sc osed most (vs. an academ c program), ved w th percept ons among youth of negat ve whom d sc osures occurred.”) More both parents or had perce ved the r they had exper enced contact sexua consequences fo ow rig d sc osure compare to ma es. The data show frequent abuse, abuse by a fam y (contact abuse w th or w thout boys (23%) reported CS& The overprotect ve. Boys were ess Nond sc osers reported more than those who had d sc osed parents as ess car rig and not parents as ess car rig and ess to ado escents w thout CS& Ado escents who reported C overprotect ve and h gh y d sc osure rate was 81 overprotect ve. a profess ona was, the ess | abuse s arse y h dden from adu t profess ona s and the ega system. how to support a sexua y abused comp ete the quest ons regard rig peer. A qua tat ve component to measured: poss b ty of reca b as the study wou d have prov ded a mp cat ons S nce fr ends appeared to be the w th retrospect ve stud es based d sc osures (whether they were nformat on and gu dance about of th s cou d be to f nd ways to man rec p ents of sexua abuse Th s study h gh ghted that sexua m tat ons nc ude a s gn f cant d sc osure was not reported. amount of boys who d d not understood a the quest ons d sc osure on: the t m rig of d sc osure processes. Study on se (-reports; and youth broader understand ng of part c pants may not have However. t me apsed to g ye young peop e better de ayed or not) was not soc ety. espec a y from d sc osures, pract ce | |
| Sorso , K a-Keat ng, and Grossman (2008) | d sc osure cha ences Study focused on | A were ntery ewed | The samp e cons sted of 16 ma e sury vors of | operant n three nterre aced doma ns: Barr en to d sc osure were found to be | S nce the vast major ty of men n the samp e had not d sc osed n | |
| for ma e sury von of CSA to understand | about the r d sc osure exper ences. Ana yt c | abuse; I I Caucas an, 2 ch dhood sexua | (I) persona (e.g ack of cogn t ve awareness. ntent ona avo dance, | ch dhood, they may have been pred spored to dent fy ng | ||
| three ssues: (I) To | techn ques nc uded | Afr can Amer can. I | emot ona read ness. and shame); (2) | barr ers to d sc osure more | ||
| (continued) |
Table I. (cont nued)¶
| Table I. (cont nued) | |||||
|---|---|---|---|---|---|
| Study | Purpose | Des gn | Samp e | F nd ngs | Summary |
| and negat ye aspects of exper ences? (2) What percept ons of pos t ve about the r d sc osure exper ences? and (3) do they have to say nc ud ng ncent ves contexts have they whom and n what the r d sc osure. What are the r d sc osed these and barren? | depth, sem -structured method of ana ys s for conceptua y c ustered approx mate y a week matr ces. Part c pants between 2 and 3 hr ntery ews, ast ng comp eted two n- grounded theory each tak ng p ace deve opment of cod ng and apart | range of 24-61 years; 9 homosexua, and 2 as dent fed themse yes as heterosexua, 5 as Puerto R can. I part Afr can Cuban: age Nat ve Amer can, b sexua | others. By the t me of the study. many of zoc ocu tura (e.g., ack of acceptance for ch d. The other men reported that they e ements of the r abuse, but concea ed a men d sc osed terra n exper ences or nd rect or ncomp ete. Seven other nc ud ng those w th fam y members, partners. therap sts, and nfrequent y exper ences n a var ety of re at onsh extent of h s sexua reported attempts to to that were men to exper ence or acknow edge re at ona (e.g fears about negat ve these men had d sc osed the r past abuse exper ences wh e he was st On y I of the 16 men n th s samp e had not d sc osed. a though some repercuss ons. so at on); and (3) d scuts ons of the r sexua abuse m ted fr ends. Seven had on y d sc osed the fu v ct m zat on). | efforts to gather a d verse samp e. H gh eve of r gor was executed read y. Retrospect ve accounts n the dependab ty of the data Invest gators made s gn f cant nterpretat on of f nd ngs was and tent ve process of the ssues. are subject to reca conducted | |
| Hershkow tz. Lanes, and Lamb (2007) | study was to exam ne The goa of the present ms of abuse d sc osed the extrafam a sexua abuse exper ence how ch d v | Invest gat ve Intery ew ntery ewed. Ch dren ntery ew, A eged v a ms of sexua nvest gat on or ch d d sc osure processes we fare ntervent on was obta ned n the exper enced youth us ng the NICHD were ntery ewed before any po ce Informat on on abuse and the r parents were nvest gators. Protoco by f rst forma | 7- to I2-year-o ds w th g r s. Ch d samp e was years. Twenty mothers ana ys s was conducted Th ny a eged v ct ms of a so ntery ewed for a ntery ews. A content an avenge age of 9.2 CSA: 18 boys and 12 and 10 fathers were on ch d and parent tota of 30 parent ntery ews | prompted. 50% of the ch dren reported react ons suggest ng ch dren ant c pated the r parents’ ke y react ons accurate y. 47% of ch dren f rst d sc osed to s b ngs fo ows: (I) de ayed 53% of the ch dren spontaneous y d sc osed abuse, but 43% de ayed d sc osure for between I week and 2 years: (2) rec p ent of d sc osure: D sc osure processes var ed depend ng ch dren d sc osed to parents). sever ty parents’ responses. Parents’ react ons: (63%). There was a strong corre at on between pred cted and acwa parenta or fr ends, 43% f rst d sc osed to the r D sc osure categor es were dent fed as on the ch dren’s ages (e.g younger support ve (37%) and unsupport ve parents. and I0% f rst d sc osed to another adu t. 57% of the ch dren fee ng afn d or ashamed of the r d sc osed on y after they were | d sc osure patterns of ntnfam a ch dren. Focus s on extrafam a CSA. Two th rds of the parents d sc osure data from young A wh ch may d Her than Innovat ve des gn to gather reg stered unsupport ve responses wit ch s h gh C |
and frequency of abuse, parents’ expected react ons, suspects’ dent t es, and strateg es used to foster secrecy rconunuedt¶
| Study | Purpose | Des gn | Samp e | F nd ngs | Summary |
|---|---|---|---|---|---|
| A agg a and K rshenbaum (2005) | current study were to dent fy a broad range h nder a ch d’s ab ty fam y dynam cs that of factors, nc ud ng The object ves of the corn bute to or to d sc ose CSA. | cod ng was conducted to capture fam y- eve barr en: and re evant transcr bed verbat m. —was phenomeno og ca L ne-by- ne open factors. Ax a and Intery ews were se ect ve cod ng dent f at on of fac tators and c rcumstances. used toe c t exper ences: —LIM d sc osure A qua tat ve fac tated themes des gn | emp oyed to recru t 20 of abuse was 6.7 years. nonc n ca samp e. The major ty had rece ved fema e and 40% ma e. treatment for CSA at Avenge age of onset Purpos ye samp ng was part c pants was 40.1 sexua y abused by a between the ages of some po nt n the r and 65 who were M xed c n ca and part c pants were fam y member. Average age of adu t sun von years: 60% of ves | te . Fam y systems formu at ons through ro es based on a patr archy-based fain y condtons ex st (I) rg dy f xed, gender that CSA d sc osure can be s gn f cant y spec f c members, payed a part n CSA v ct ms fee ng they had no one safe to commun cat on patterns; and (4) soc a understand ng ch dren and fam es at Four major themes emerged suggest ng so at on of the fam y as a who e, or v o ence; (3) c osed, nd rect fam y comprom sed when certa n fam y structure; (2) presence of fam y mportant n r sk of d sc osure barr en a fem n st ens are | through cred b ty. dependab ty. and conf rmab ty through d rect part c pants, s x d d not d sc ose ch dhood. Of the nond sc os ng Over ha f the part c pants had not trustworth ness of the data and mp es needed on ear y d sc osures to because they had repressed or forgotten the memory. A most nterpretat ons were ach eyed one th rd w thhe d d sc osure garner more nformat on on ntent ona y. More data are d sc osed the abuse dur ng ssues. H gh eve of atop of d sc osure. Retrospect ye approach quotes reca fac |
| A au a (2005) | by exam n ng a range of to qua at ve y exp ore or promote d sc osure — fema es and ma es are dynam cs that mpede The study purpose was s m ar and d fferent. gender as a dynam c gender affects CSA how d sc osures of and n what ways factors nc ud ng d sc osure | deve opment regard ng exper ences us ng LIM. cod ng. Categor es and d sc osure. Intery ews co apsed and ref n ng part c pant narrat ves Sury von of CSA were mpact of gender on was used for theme subcategor es were verbat m for open. ax a . and se ect ve ntery ewed about were transcr bed nto theme areas the r d sc osure Ana ys s of 30 | women and men. a ong d d not. I9 fema es and nonwh te, and 58% had II ma es; 18-65 (mean age of abuse onset was trusted adu t. Avenge 40.1) years who were abuse and those who not d sc osed dur ng sexua y abused by a 5.3 years, 36% were d sc osed dur ng the Purpos ve samp ng of fam y member or a w th those who ch dhood | about who was respons b e for the abuse so at on because of the be of that boys d sc os ng: (I) they fe t more conf cted nh b ted or prec p tated d sc osure for and (2) they more strong y ant c paced reasons re ated to gender: (I) fear of profound fee ngs of st gmat zat on or becom ng an abuser, wh ch acted as a are rare y v ct m zed; and (3) fear of Three themes emerged for men that be ng b amed and/or not be eyed predom nant themes w th fema e be ng v ewed as homosexua : (2) part c pants re ated to d ffcu t es prec p cant for d sc osure. Two | Retrospect ve des gn of the study through cred b ty. dependab ty. and conf rmab ty through d rect Comparat ye ana ys s draws out mp cat ons. trustworth ness of the data and nterpretat ons were ach eyed One n a dearth of stud es that mp es poss b e reca conduct gender ana ys s. ssues. Hgh eve of mportant pract ce quotes wh ch |
| Co ngs, Gr ffths. and Kuma o (2005). | of d sc osure n a arge Study exam ned patterns represent ve samp e of South Afr can CSA v ct ms. Two study exam ne how and object ves to: ( I ) | case center where a cases soc a f es for CSA v ct ms of CSA reported to the North Durban seen at the cr s s work and med a F e rev ews of a | reported n the North KwaZu u-Nata . South Afr ca, dur ng January 2003. 1,614 grs and 2001 to December 1.737 cases of CSA Durban area of | process. These d sc osure d mens ons tempon durst on: an event versus a d mens ons of d sc osure: (I) agency: Content ma ys s dent fed two broad def ned four d screte categor es of detect on by a th rd party and (2) ch d- n t aced d sc osure versus | These resu tsft nto A agg a’s (2004) exhaust ve and mutua y exc us ve d sc osure framework. Through author’s d sc osure framework, data ana ys s two raters coded d sc osure categor es us ng wh ch proved to be both |
| (continued) |
•-•1¶
Table I. (cont nued)¶
| Table I. (cone nued) | |||||
|---|---|---|---|---|---|
| Study | Purpose | Des gn | Samp e | F nd ngs | Summary |
| and (2) Ident fy factors d fferent patterns of d sc ose the r abuse when CSA v ct ms assoc ated w th d sc osure | per od of January 2001 referred dur ng the to December 2003 po c ng area were | abuse, 31% from 72 hr 123 boys: average age of v ct m zed ch dren month, and 22% more than a month reports were made w th n 72 hr of the was 9.9 years. 47% after the abuse to I | re at onsh p. offender’s age. frequency of abuse. and report ng atency. Mean age of ndependent y pred cted by v a m’s age. (9% of cases), (3) eyew tness detect on offender was a fam y member. Shorter key w th (30% of cases), (2) nd rect d sc osure detect on (43% of cases). D sc osure h gher than the mean age of nd rect d sc osure: (I) purposefu d sc osure ke y when the d sc osures (5.84). Exp c t forms of purposefu d sc osures (10.67) was (18% of cases), and (4) acc dents —perpetrator report ng atency was more d sc osure were ess nature of the v ct m repeated abuse | m ted to ch d o ents rece v ng a w th the percentage of nternter Genera zab ty of th s study s cr s s assessment referred through a po ce report agreement at 98%. | |
| Hcrshkow a, Horow and Lamb (2005). | dent fy character st cs abuse v a ms that are nond sc osure dur ng nvest gat ons of suspected ch d Th s study a med to assoc ated w th d sc osure and forma | and 2002 was ana yzed. Protoco . Arch va data Invest gat ve Intery ew standard zed NICHD abuse nvest gated n Intery ews were a so Is ne between 1998 suspected cases of phys ca and sexua conducted us ng Large database of were ana yzed | compr sed of 26.446 of 2002. 140 exper enced conducted ntery ews per od from 1998 to abuse ntery ewed n n the 5-year sexua and phys ca a eged v ct ms of 3- to14-yearn d The camp e was toned youth nvest gators Israe | d sc osure were greater for sexua abuse d sc osela ege abuse when a parent was 50% w th 3- to 6-yearn ds. 67% of the 7- Oven , 65% of the 26,446 ch dren made rates ncreased as ch dren grew o der. to I0-year-o ds. and 74% of the I I- to a egatons when ntery ewed. Rates of key to the suspected perpetrator. D sc osure I4-year-o ds d sc osed abuse when %). Ch dren of a ages were ess %) over phys ca abuse (61 quest oned (71 | off c a agenc es. mak ng t d ff cu t take p ace w thout ever tr gger ng of d sc osure var ed systemat ca y mo ved cases that to determ ne how many of abuse Oven f nd ngs nd cated that rates a eged offences. the re at onsh p suspected perpetrators. and the nvest gat on depend ng on the nature of the had come to the attent on of age of the suspected v a ms. between a eged v a ms and any k nd of off c a Ana yses on y |
| Moss ge, Re the t. and Jensen. Gu brandsen, Tjers and (2005) | parent’s percept ons of v ews as to what made t d ff cu t to ta k about them n the d sc os ng ch dren were ab e to the context n wh ch Th s study nvest gated abuse: what he ped process: and the r exper ences: the r report the r ch d the r d sc osure sexua abuse processes | were ana yzed through Therapeut c ntery ews a qua tat ve approach. were he d I year ater Qua tat ve approach to most y the r mothers Fo ow-up ntery ews data co ect on and o the ch dren and ana ys s was used. | 20 fam es w th a tota of ch dren had to d about care-g vers about CSA. Ch dren’s ages ranged years (average age 7.5 boys. Sexua y abused created concerns for years): 15 g r s and 7 person to the fam y by someone n the between 3 and 16 exper ences that tam y or a c ose part c pated. A 22 ch dren | s tuat ons conta n ng enough pr vacy and exposed to repet t ye abuse kept th s as a mmed ate y after t occurred. Ch dren s tuat ons where someone engaged the the r mothers f rst, 3 f rst to d a fr end. The ch dren fe t t was d ff cu t to f nd secret for up to seven years: 17 to d bother ng them, resu t ng n a referra When the ch dren d d prompts that they cou d share the r Major ty of remarks that ed to the to d the r father, and I the r unc e. ch d nada ogue about what was None of the ch dren to d of abuse susp con of CSA were made n exper ences. | ta k. a purpose for speak ng and a connect on has been estab shed process that becomes ess d ffcu t f ch dren perce ve that there s an opportun ty to to what they are ta k ng about. Ev dence for de ayed d sc osures. mportant d sc osure s a fundaments y Strengthen ng parent ch d The resu is nd ate that mp cat on re at onsh ps s an pact ce d a og a |
ICOtitinUed)¶
| Table I. (coot nued) | |||||
|---|---|---|---|---|---|
| Study | Purpose | Des gn | Samp e | F nd ngs | Summary |
| a so sens t ve to the ch dren’s fee ngs. If cues and probed further. They a so were concerned about negat ve effects for the wou d change the subject or not pursue m s nterpreted. Seven of the ch dren where someone recogn zed the ch d’s d sc ose they d d t n s wat ons where the r ch dren showed s gns of d stress major factors contr but ng to de ay ng and d d not want to ta k. the mothers the top c of ch d sexua abuse was n mother. The mothers sad they were perce ved negat ve consequences as whether the r d sc osures wou d be some form addressed or act vated. sens t ve to others react ons, and d sc osure. They were pr mar y the top c further | |||||
| Sta er and Ne son- Garde (2005) | The purpose of th s study was to understand the h ndered d sc osure process of CSA d sc osure and how preado escent and th s unfo ded for ado escent g r s. and subsequent Exam ned what consequences fac tated and fu | narrat ye summar es of qua tat ve focus group cons seed of four focus each secs on group ng data. Or g na project w th n the context of cons seed of wr tten ongo ng therapy for and exam n ng the r nterconnectedness Secondary ana ys s of these conceptua y, Secondary am ys s groups conducted exper enced CSA. g r s who had | between 60 and 90 m n part c pants from four ong: and otaped and Samp e cons seed of 34 ater transcr bed for groups. Sess ons content am ys s ana yzed were | react on phase: where they se ect a t me, responses and the after fe of te ng. and consequences phase: good and bad that doma ns: ( I ) se (-phase: where ch dren react ons of adu is were s gn f cant and m (4) ns der and outs der commun t es strateg es of te ng. The act ons and whether that person’s react on was chang ng re at onsh ps, (3) nst tut o F nd ngs are reported n three major cone nued to nform the r ongo ng come to understand v ct m at on p ace, and person to te and then Boss p ng and news networks, (2) nformed the g r s’ dec s ons. The nterna y (2) conf dant se ect on- consequences phase was further subd v ded nto four aspects: (I) support ve or host e: and (3) | the r know edge for the benef t of po nt n t me when the abuse and d sc osure occurred. Sma groups d sc osure process. c oser to the of preado escent and ado escent abuse a so served as consu tants and were encouraged to share Th s study prov ded a contextua g r s who had sury ved sexua exam nat on of the ent re profess ona prate t oners |
| A agg a (2004) | ch dren’s d sc osure of CSA to address gaps n that nh b t or promote know edge about how, when, and under what c rcumstances v a ms exam ne nf uences The study sought to of CSA d sc ose | ntery ew ng that were themat c am ys s. The 2 hr ong on average generated data for a ntery ew gu de was The study emp oyed phenomeno og ca des gn. Intens ve —a LIM | Us ng purpos ye samp ng from agent es and one 24 adu t sun von of 41.2) were recru ted un vers ty: 57% ma e and 65 (average age between ages of 18 ntnfam a abuse and 43% fema | prompted!e c ted accounted for 42% of Over ha f the d sc osure patterns descr bed d sc osure patterns n the study samp e. categor es of d sc osure were dent fed prey ous y dent f ed were conf rmed n purposefu . and by the study samp e d d not f t these Through ana ys s of the ntery ew new to add to ex st ng types. Three these data: acc denta | c rcumstances. Ask ng peop e to adu is d sc ose. And under what recount events that occurred n Th s study expanded types of CSA memory ft ure. espec a y when understand how ch dren and ch dhood s suscept b e to memor es were forgotten. d sc osures to more fu y |
(continued)¶
| Study | Purpose | Des gn | Samp e | F nd ngs | Summary |
|---|---|---|---|---|---|
| deve oped to probe env ronmenta . and of uenc ng CSA cu tura factors for nd v dua , nterpersona . d sc osure | 42% of the part c pants average age of abuse onset was 6.5 years: d sc osed as adu is had d sc osed the ch dhood: 58% abuse dur ng | prey ous y estab shed categor es. Three emerged: behav ora and nd rect verba w thhe d. and d sc osures tr ggered by attempts. d sc osures ntent ona y add t ona d sc osure categor es recovered memor es | potent a prob ems nreca . H gh degree of trustworth ness of the de ayed. or repressed and ater data was ach eyed and quotes rev s on of events are a so recovered. D stop on and prov ded supported the | ||
| Cr sma, Basce , Pac. and Rom to (2004) | and seek ng he p from from d sc os ng CSA the r soc a network prevent ado escents The ma n goa s of th s and/or the sery ces mped menu that study were to understand | nformed consent was accord ng to a cod ng counse ng conducted ndependent y scored the ntery ews wh ch were recorded w th perm ss on. Three In-depth to ephone ntery ews were obta ned. Three conducted after counse ng CSA exper enced n the ntery ews exp a ned and (anonymous) nvest gators researchers | compr sed of 36 young 35 fema es and I ma c abuse n ado escence: aged 12-17. Some of v o ence n a dat ng exper enced sexua exper enced sexua The samp e was peop e who re at onsh p the samp e | consequences of d sc os ng sexua abuse. When they d d d sc ose to profess ona s. many profess ona s were not tra ned on adu ts and profess ona s. and fear of the were: unaware of appropr ate sery ces. awareness of be ng abused, m strust of fam y member were: fear of not be ng m ted support as mped menu for not seek ng sery ces The ma n mped menu to d sc ose to a appropr ate ntervent ons co v ct ms ng sexua abuse and cou d not offer w sh to keep the secret. ack of troub e to the fam y. The ma n be eyed, shame, and fear of at teens rece ved very | of a m xed samp e of sun von of c ear what sexua abuse response Th s study represented the f nd ngs have been a se ect on b as as the partner v o ence. The study was ch d sexua abuse and nt mate conducted n Ita y and t s not tra n ng s an ab e. There may responded to the research ca most d scat sf ed sury vors categor es |
| Jonzon and L ndb ad (2004) | react ons were probed support were re ated. D fferences based on t m ng and outcomes pos t ve and negat ve d sc osure. and soc a pred a ng factors of Study purpose was to exp ore how abuse of d sc osure. soc a sever ty of abuse. react ons to CSA tra ts. openness, support. and | CSA by someone c ose data on d sc osure and current soc a support us ng sem -structured Adu t women report ng gathered through the gu des together w th quest onna res. Data on v a m zat on and quest onna res, and were ntery ewed react ons were were retr eyed through the framework | to d someone about at someone c ose before east one abuse event years o d (average age of 41 years) report ng the age of I8 and had samp ng strategy was between 20 and 60 subjects. Purpos ve 90% were Swed sh exposure to ch d sexua abuse by 122 adu t women used | use of v o ence, and were more ke y to perpetrators was more common than by d sc osed dur ng ch dhood (before the ch dhood reported more nstances of a s ng e perpetrator. Age of onset was often before age of 7. w th an average age of 18) w th an average of 21 years Abuse character st a: abuse by mu t p e phys ca abuse, mu t p e perpetrators. de ay. Women who had d sc osed n durat on of 7 years. Severe y abused women had to ked to more of the r profess ona s. D sc osures: 32% soc a network. espec a y to | between soc a support networks m ts the accuracy stud es to focus on the nterp ay of the nformat on obta ned on overrepresentat on of severe y abused women. Retrospect ve adu thood. At the t me of the and d sc osure of ch d sexua nformat on cou d mp y reca study, t was one of the f rst abuse. The study resu u are 68% de ayed d sc osure unt study and se f-report of m ted by an ssues and thus somewhat |
| ntery ews w th part c pants | rece ved a negat ve f rst react on. Factors have confronted a perpetrator, and had | (continued) character st a. Cross-sect ona abuse and d sc osure |
Table I. (tont nued)¶
| Table I. (cont nued) ;el a. | |||||
|---|---|---|---|---|---|
| Study | Purpose | Des gn | Samp e | F ndngs | Summary |
| younger age at f rst event and no use of v o ence. D sc osure outcomes: of the 26 women who to d n ch dhood dur ng a per od w th ongo ng abuse, IS women s gn f cant y pred ct ng de ay were were cont nuous y abused after d sc osure | des gn does not a ow for def n te conc us ons of cause and effect on the re at onsh ps found | ||||
| Kogan (2004) | and the rec pent of the The purpose of th s study was to dent fy factors pred tears of both the USE n ch dhood and d sc osures made by t m ng of d sc osure fema e sury vors of that of uence the ado escence. The d sc osure were nvest gated | Data were gathered from mod f ed vers on of the then asked a ser es of a subsamp e of fema e NSA, wh ch cons sted were assessed us ng a Inc dent C ass f cat on Intent ew. They were quest ons about each reported n the NSA ep sode of unwanted of structured phone character st a and part c pared n the ntery ews. USES ado escents that nc ud ng event sexua contact character st a perpetrator | years o d, mean age of reported at east one contact n the NSA. character st a. USE 15.2 years o d, who character st a. and between 12 and 17 ado escent fema es A subsamp e of 263 fam y contextua unwanted sexua attr butes were exper ence of exp ored Part c pant | between the ages of 7 and 13 were most than ch dren aged 7-10 years. Ch dren Fam y factors nked to d sc osure were on y peers aged II-13 tended to d sc ose w th n a v ng w th both parents was assoc ated key to te an adu t. Ado escents (14- ones fe dur ng and penetrat on were d sc ose more prompt y and (2) never Immed ate d sc osure was more ke y d sc osure beyond a month. Ch dren key to (I) drug abus ng househo d member, perpetrator or a fam y member was under II were more ke y to te an assoc ated w th d sc osure to adu ts. w th stranger perpetrat on. Fear for Ch dren under the age of 7 were at a assoc ated w th de ayed d sc osure. h gher r sk for de ayed d sc osures. adu t. but were at r sk for de ay ng month. C oser re at onsh p to the Part c pants whose USE occurred wh ch made sury von more 17) were more ke y to te | exper ences may be b ased due to underreport ng. Ado escents who d sc ose USE v a survey. A though th s study s nce part c pants were for nvest gat ons of v ct m zat on b as may have been m n m zed n part c pared n the NSA. Surveys nat ona y representat ye samp e the resu ts genera zab e on y to ado escents. and so the t me ag systemat c b as and wou d make data may be retrospect ye, reca nc ud ng d sc osures of USES n USE may represent a source of refused to report or d scuss an ch dhood and ado escence n a ng to shorter than a study of adu t ntery ew were presumab y of fema e ado escents who Th s study exam ned factors part c pants reca ng CSA between the USE and the ado escents who are w |
| Ede ste n. Goodman. Jones, and Gordon Goodman-Brown, (2003) | The purpose of th s study d sc osure of CSA and factors that of uence d sc ose sexua abuse how qu ck y ch dren var ab es assoc ated was to nvest gate test a mode for w th de ay of | graduate students and Case f e rev ews of data structured ntery ews comp eted the Sexua observat ons of ch d m advocate prosecut on f es, as ntery ews. Tn ned w th the ch dren ‘s obta ned from Assau t Prof e caretaker and we as from one v ct | abuse n some manner. of the abuse, and 4-16 years at the t me of the Ch dren ranged n age the beg nn ng of abuse; ch dren n the samp e Samp e cons sted of 218 3-16 years at the end from 2 to I6 years at dr dren referred to prosecutors’ off ces for a eged CSA. A had d sc osed the r | feared greater negat ye consequences to mode were tested. (I) age: ch dren who were o der took onger to d sc ose and w th n 6 months. F ve var ab es for the extrafam a abuse: (3) fear of negat ve —v ct ms of ntrafam a abuse consequences to others than younger ch dren: (2) type of abuse: v ct ms of 64% d sc osed w th n a month and 29% o der ch dren feared more negat ve consequences: ch dren who feared ntrafam a fam es took onger to others compared to v ct ms of w th nond sc osure d sc ose | author t es and were n process of These cases had been reported to extrafam a abuse (52%) may a so Th s study represents a h gher rate Lega samp e w th h gher rate of abuse: fe t greater respons b ty h gher rate of ear y d sc osures. prosecut on wh ch may exp a n account for ear er d sc osures. ch dren, v ct ms of ntrafam a of d sc osers w th n a month. for the abuse, and perce v ng Mode suggests that o der exper ences |
(continued)¶
| Table 1. (coot nued) |
|---|
| Study | Purpose | Des gn | Samp e | F nd ngs | Summary |
|---|---|---|---|---|---|
| Sm th. Letourneau. | The study focus was to | quest onna re for ch d causa re at ons among respons b ty and fear were conducted w th d sc osure. Ch dren’s path ana yses to test consequences were Corre at ona ana yses Structured te ephone character st cs. the the hypothes zed abuse and the r percept on of of negat ve var ab es probed. | Two probab ty samp es. Predom nant y m dd e n t a po ce report: H span c. and I I% ntrafam a abuse Mr can Amer can. Approx mate y 47% 77% fema e. 70% Caucas an. 17% to ow SES. | unre ated to t me of d sc osure. and g r s to d sc ose and o der ch dren fe t more respons b ty for the abuse took onger respons b ty: ch dren who fe t greater d sc ose, fear of negat ye consequences gender was not s gn f cant y corre ated consequences to others: (4) Perce ved took onger to d sc ose, ch dren who 288 (9%) reported exper enc ng at east br ng harm to others took onger to negat ve consequences of d se osure be eyed that the r d sc osure wou d respons b ty for the abuse: and (5) to the se f or the perpetrator was more than boys feared negat ye w th t me to d sc osure | d sc os ng took onger to d sc on. The t me frame of th s survey may eve of r gor. Produced a v ab e mode of d sc osure for further We -des gned study w th h gh researchers were not ab e to ntery ew ch dren d rect y negat ve consequences to nvest gat ons. However. |
| Saunders, K paw ck. Resn ck and Best (2000) | arge samp e of women who they d sc osed to. were raped before age 18 de ayed d sc osure pred cted d sc osure about the ength of gather data from a t me women who and var ab es that month w th n I | m zat on computer screen. The psych atr c symptoms. approx mate y 35 m n data us ng a computer- were conducted w th ntery ews that asted reports on data from the demograph c and te ephone ntery ews v ct m zat on h story. were used to co ect ntery ew system. A survey cons sted of each quest on on a substance use, and ass sted te ephone The present study des gned toe ct seven measures ch d rape v a demograph c nformat on. quest ons | data were we ghted to and un seed te ephone 2.000 women between Wave I was a random from stmt fed samp es the ages of 18 and 34 respondents se ected conform to the 1989 househo ds for seed Wave I and Wave 2 Random d g ta d a rig was used to so c t Was se ected. Both random samp e of numbers. Second Census stat st a samp e of 2.009 jur sd ct ons. of def ned | t me of the f rst rape was 10.9 years. Of one event that met the study’s def n t on rape. 28% stated that they had never to d over 1 year and up to 5 years post-rape. of ch dhood rape. The average age at the workers or aw enforcement personne . ms made d sc °sures, fo owed by mothers for th s study. 58% d d not d sc ose for WS ntery ew c ose fr ends were the 27% d sc osed w th n a month. Among y quer ed by the ntery ewer and other mmed ate fam y members. the 288 women who reported a ch d nta dsc osure to soc a On y 12% of ch d rape v ct ms stated women who d sc osed pr or to the r ms reported that the r assau is were reported to anyone about th s sexua assau t unt most common person to whom v a author t es at some po nt Fewer than 10% of ir a mak ng the r spec f a N | wrong and Thou d be d sc osed to reported by th s samp e occurred (and may current y be nf uenc ng) patterns. For Wave I, compar son U.S. Census Bureau nd cated that of these data w th the popu at on mp cat ons. programs that were begun n the nformat on may have nf uenced the samp e c ose y matched the parameters obta ned from the I 980s that teach ch dren that demograph c attr butes of the assau t prevent on educat on pr or to the arge-sca e ch d assau is ( nc ud ng CSA) are The major ty of ch d rapes young women’s d sc osure popu at on of U.S. women respons b e adu u. Th s have had contextua |
examples of this usage were found in the research questions, interview guides, and surveys examined: “How and when do people decide to tell others about their early sexual experiences with adults?” (Hunter, 2011, p. 161); “Some men take many years to tell someone that they were sexually abused. Please describe why it may be difficult for men to tell about/discuss the sexual abuse” (Easton, Saltzman, & Willis, 2014, p. 462). “Participants were asked a series of open-ended questions to elicit a narrative regarding their experiences of telling…” (McElvaney, Greene, & Hogan, 2012, p. 1160). “Who was the first person you told?” (Schaeffer, Leventhal, & Anes, 2011, p. 346).¶
There was sound consistency between studies, defining disclosure in multifaceted ways with uniform use of categories of prompted, purposeful, withheld, accidental, direct, and indirect. However, defining the period of time that would delineate a disclosure as delayed varied widely across studies, wherein some studies viewed I week or I month as a delayed disclosure (i.e., Hershkowitz et al., 2007; Kogan, 2004; Schembucher, Maier, Moher-Kuo, Schnyder, & Lamdolt, 2012). Other studies simply reported average years of delay sometimes as long as from 20 to 46 years (Easton, 2013; Jonzon & Linblad, 2004; Smith et al., 2000).¶
Second, the number of qualitative studies has increased significantly over the last 15 years. This rise is in response to a previous dearth of qualitative studies. Based on Jones’s (2000) observation that disclosure factors and outcomes had been well documented through quantitative methods; in a widely read editorial, he recommended “Qualitative studies which are able to track the individual experiences of children and their perception of the influences upon them which led to their disclosure of information are needed to complement … ” (p. 270).¶
Third, although a few studies strived to obtain representative samples in quantitative investigations (Hershkowitz, Horowitz, & Lamb, 2005; Kogan, 2004; Smith et al., 2000), sampling was for the most part convenience based, relying on voluntary participation in surveys and consent-based participation in file reviews (Collings, Griffiths, & Kumalo, 2005; Priebe & Svedin, 2008; Schembucher et al., 2012; Ungar, Barter, McConnell, Tutty, & Fairholm, 2009a). Therefore, generalizability of findings is understandably limited. The qualitative studies used purposive sampling as is deemed appropriate for transferability of findings to similar populations. Some of those samples contained unique characteristics, since they were sought through counseling centers or sexual advocacy groups. These would be considered clinical samples producing results based on disclosures that may have been delayed or problematic. This might presumably produce data skewed toward bathers and bring fonvard less information on disclosure facilitators.¶
Through an in-depth, second-level analysis, this review identified five distinct themes and subthemes beyond the general trends as noted earlier.¶
Theme 1: Disclosure is viewed as an ongoing process as opposed to a discrete event—iterative and interactive in nature. A subtheme was identified regarding disclosure as being facilitated within a dialogical and relational context is being more clearly delineated.¶
Theme 2: Contemporary disclosure models reflect a social—ecological, person-in-environment perspective to understand the complex interplay of individual, familial, contextual, and cultural factors involved in CSA disclosure. Subthemes include new categories of disclosure and a growing focus on previously missing cultural and contextual factors.¶
Theme 3: Age and gender are strong predictors for delaying disclosure or withholding disclosure with trends showing fewer disclosures by younger children and boys. One subtheme emerged that intrafamilial abuse/family-like relationship of perpetrator has a bearing on disclosure delays or withholding.¶
Theme 4: There is a lack of a cohesive life-course perspective. One subtheme includes the lack of data within the 18 to 24-year-old emerging adult population.¶
Theme 5: Significantly more information is available on barriers than on facilitators of CSA disclosure. Subthemes of shame, self-blame, and fear are uniformly identified as disclosure deterrents.¶
Disclosure as an ongoing process: Iterative and interactive in nature. Disclosure is now generally accepted as a complex and lifelong process, with current trends showing that CSA disclosures are too often delayed until adulthood (Collin-Vezina et al., 2015; Easton, 2013; Hunter, 2011). Knowledge building about CSA disclosure has moved in the direction of understanding this as an iterative and interactive process rather than a discrete, onetime event. Since the new millennium, disclosure is being viewed as a dynamic, rather than static, process and described “not as a single event but rather a carefully measured process” (Alaggia, 2005, p. 455). The catalyst for this view originates from Summit (I 983) who initially conceptualized CSA disclosures as process based, although this notion was not fully explored until several years later. Examinations of Summit’s (1983) groundbreaking proposition of the CSA accommodation (CSAA) model produced varying results as to whether his five stages of secrecy, helplessness, entrapment and accommodation, delayed, conflicted, and unconvincing disclosures, and retraction or recantation, hold validity (for a review, see London, Bruck, Ceci, & Shuman, 2005). However, the idea of disclosure as a process has been carried over into contemporary thinking.¶
Recently, McElvaney, Greene, and Hogan (2012) detailed a process model of disclosure wherein they describe an interaction of internal factors with external motivators which they liken to a “pressure cooker” effect, preceded by a period of containment of the secret. Moreover, this and other studies strongly suggest disclosures are more likely to occur within a dialogical context—activated by discussions of abuse or prevention forums providing information about sexual abuse (Hershkowitz et al., 2005; Jensen, Gulbrandsen, Mossige, Reichelt, & Tjersland, 2005; Ungar et al., 2009a). The term¶
dialogical simply means to participate in dialogue. Key dialogical vehicles identified in these studies were providing sexual abuse information through prevention programs, being asked about sexual abuse, and being prompted to tell (McElvaney et al., 2012; Ungar et al., 2009a).¶
Contemporary models of CSA disclosure reflect a social cological perspective. Knowledge on CSA disclosure has been steadily advancing toward a holistic understanding of the complex interplay of individual, familial, contextual, and cultural factors (Alaggia & Kirshenbaum, 2005; Brazelton, 2015; Fontes & Plummer, 2010). Where at one time factors examined and identified were predominantly of intrapersonal factors of child victims, knowledge construction has shifted to fuller social ecological, person-in-environment explanations (Alaggia, 2010; Collin-Vezina et al., 2015; Easton et al., 2014; Hunter, 2011; Ungar, Tutty, McConnell, Barter, & Fairholm, 2009b). Social-ecological explanations open up more opportunities to intervene in facilitating earlier disclosures. Alaggia (2010) proposes an ecological mapping of what individual, interpersonal, environmental, and contextual influences impede or promote CSA disclosures based on analysis of in-depth interview data of 40 adult survivors. Subsequently, based on a sample of 67 adult survivors, Collin-Vezina, Sablonni, Palmer, and Milne (2015) identified three broad categories, closely aligned with an ecological framework that impede CSA disclosure: (1) barriers from within, (2) barriers in relation to others, and (3) bathers in relation to the social world which can be aligned to intrapersonal, interpersonal, and contextual factors.¶
A summary of knowledge building using a social—ecological framework follows. Knowledge gained in the intrapersonal domain includes expanded conceptualization of disclosure by building on previous categories of accidental, purposeful, and prompted disclosure to also include behavioral and indirect attempts to tell, intentionally withheld disclosure, and triggered and recovered memories (Alaggia, 2004). Categories of indirect behavioral disclosure patterns have been further verified in follow-up research by Hunter (2011), and through an extensive file review that used Alaggia’s (2004) disclosure framework to analyze their data (Collings et al., 2005) for verification.¶
Interpersonal factors have also emerged in regard to certain family characteristics as disclosure barriers. Families with rigidly fixed gender roles, patriarchal attitudes, power imbalances, other forms of child abuse and domestic violence, chaotic family structure, dysfunctional communication, and social isolation have been found to suppress disclosure (Alaggia Kirshenbaum, 2005; Collin-Vezina et al., 2015; Fontes & Plummer, 2010). In addition, relationship with perpetrator is a factor whereby research indicates that disclosure is made more difficult when the perpetrator is a family member or close to the family (Dumont, Messerschmitt, Vila, Bohu, & Rey-Salmon, 20 I 4;Easton, 2013; Goodman-Brown et al., 2003; Hershkowitz et al., 2005; Priebe & Svedin, 2008; Schanbucher et al., 2012). This is especially a barrier when the perpetrator lives with the victim (LeClerc & Wortley, 2015).¶
neighborhood/community conditions can hinder disclosure when there is lack of school involvement in providing a supportive environment, such as in following up on troubling student behavior (Alaggia, 2010). Additionally, a child victim’s anticipation of a negative response to disclosure, especially that they may not be believed by others outside their family such as neighbors or other community members, has shown to deter disclosure (Collin-Vezina et al., 2015).¶
Cultural factors influencing CSA disclosure have been studied to a much lesser degree. Despite this, a few important studies examining critical sociocultural factors now exist for better understanding CSA disclosure within a cultural context (Brazelton, 2015; Fontes & Plummer, 2010). Among these important contributions, Brazelton’s (2015) research has delineated CSA disclosure processes as “shaped by relational, racial, socio-cultural, historical, and developmental factors” (p. 182). In a unique study using culturally focused research literature as data triangulated with clinical case material, culturally based belief systems in many cultures have been found to foster family climates that can silence children from disclosing abuse (Fontes & Plummer, 2010). Taboos about sexuality, patriarchal attitudes, and devaluation of women are among some of the cultural barriers that inhibit disclosure (Fontes & Plummer, 2010).¶
Clearly, disclosure conceptualizations are being integrated into a social—ecological model of individual and developmental factors, family dynamics, neighborhood, and community context as well as cultural and societal attitudes toward better understanding disclosure barriers and facilitators (Alaggia, 2010), although more data are needed on cultural and contextual factors.¶
Age and gender as predictors of disclosure¶
Age. Age is consistently found to be an influential factor in CSA disclosure, making the life stage of the victim/survivor a critical consideration. Studies draw distinctions in age-groups falling into either under or over 18 years of age. Eighteen years of age was the common age cutoff point that investigators chose in order to distinguish child/youth populations from adult samples. Sixteen of the studies drew on samples of children and youth, while the other 15 studies sampled adults over the age of 18, and a further two studies used mixed age-groups (refer to Table I). Among the child and youth samples, the age ranges spanned from preschool to late adolescence (3-17 years of age), with varying methodological approaches implemented across age cohorts. For younger cohorts, file reviews and secondary data analyses of CSA reports were typically undertaken. Adolescents were most often given surveys. Sometimes children and youth were interviewed as part of administering a survey or as a follow-up (Crisma et al., 2004; Hershkowitz et al., 2005; Ungar et al., 200%). In the majority of child and adolescent samples, sexual abuse concerns were already flagged to investigative authorities. However, the work of Ungar, Barter, McConnell, Tutty, and Fairholm (2009a, 200%) is one exception, whereby their survey elicited new disclosures.¶
Adult studies typically had a mean age between 40 and 50 years. Interviews were the main data collection method with a few exceptions using survey designs (i.e., Easton, 2013; Kogan, 2004; Smith et al., 2000) and case file reviews (i.e., Collings et al., 2005; Goodman-Brown et al., 2003). Results show a clear trend toward increased likelihood of disclosure in older youth, and findings from adult samples showing a preponderance of disclosures in adulthood, with the large majority of participants of adults reporting never having had a sexual abuse complaint filed with investigative authorities as a child or an adolescent (i.e., Hunter, 2011; Gagnier & Collin-Vezina, 2016; Sorsoli, Kia-Keating, & Grossman, 2008; Ungar et al., 200%).¶
With children and youth under the ages of 18 distinct patterns emerged. First, accidental detection, rather than purposeful disclosure, is more likely to occur with younger children. For example, in one large-scale study of over 1,737 file reviews, over half of the CSA-related cases were identified through accidental and eyewitness detection (61%), while less than one third were purposeful disclosures initiated by the child victim (Collings et al., 2005). A second pattern which emerged is that rates of disclosure increase with age, especially into adulthood, which is supported by persistent findings of high rates of delayed disclosure reported later in the life course by adult survivors (Collings et al., 2005; Collin-Vezina et al., 2015 ; Easton, 2013; Jonzon & Linblad, 2004; Kogan, 2004; Leclerc & Wortley, 2015; Sorsoli et al., 2008). While gender and relationship with the perpetrator are considerable factors in CSA disclosure, age is consistently a stronger predictor of disclosure (or nondisclosure) (Hershkowitz et al., 2005; Leclerc & Wortley, 2015). Third, younger children who disclose are more likely to do so in an interview situation or other environment that provides prompts or questions about sexual abuse (Hershkowitz et al., 2005; McElvaney, Greene, & Hogan, 2014; Schaeffer et al., 2011), but this trend can also be seen in older youth (Ungar et al., 2009a, 2009b).¶
Gender. A number of studies have recently focused on CSA disclosures with male victims, since males have been an understudied population (Alaggia, 2005; Easton, 2013; Easton et al., 2014; Gagnier & Collin-Vezina, 2016). Most investigations that sampled both sexes show females outweighing male participants. Although women are at double the risk of being subjected to CSA, the ratio of women to men in most disclosure studies has not been representative. This finding may be indicative of male victims more likely delaying disclosing their CSA experiences, leaving male disclosure in child and youth samples underrepresented (Hebert, Tourigny, Cyr, McDuff, & Joly, 2009; Ungar et al., 2009b).¶
Easton, Saltzman, and Willis (2014) have been developing gender-specific modeling of disclosure examining male disclosures. Their proposed model groups male disclosures into barrier categories as determined by individual factors, interpersonal issues, and factors that are sociopolitical in nature. These authors suggest that predominant gender norms around masculinity reinforce the tendency for male victims of CSA to blame themselves¶
for the abuse, resulting in no disclosure. Male participants in a subsequent study also relayed that gender norms and stereotypes contributed to them concealing the abuse because they were abused by a woman (Gagnier & Collin-Vezina, 2016). In the one study that compared male and female disclosures, investigator found that men’s fears of being viewed as homosexual; profound feelings of stigmatization or isolation because of the belief that boys are rarely victimized; and fear of becoming an abuser acted as disclosure barriers. Whereas females felt more conflicted about who was responsible for the abuse and more strongly anticipated being blamed and not believed (Alaggia, 2005).¶
Lack of a life-course perspective. Given that the study of CSA disclosure draws on age-groups ranging from samples of very young children to retrospective studies of adult survivors, with significant developmental considerations, this area of study lacks an intentional cohesive life-course perspective. Most data are derived from either cross-sectional or retrospective designs, with few longitudinal studies. There are a series of sound, yet disconnected, studies focusing on specific age-groups of children and adolescents, along with adult retrospective studies. Thus, the available knowledge base does not allow for a cohesive picture of CSA disclosure processes and pathways over the life course to emerge.¶
The life-course perspective has long been recommended as a critical lens for the study of child abuse (Browning & Laumann, 1997; Williams, 2003). For example, a life-course perspective has been utilized to understand the immediate- and long-term effects of CSA on the developing child victim (Browning & Laumann, 1997). Further, a life-course perspective is important in terms of examining age of onset of CSA to explain the differential effects of sexual victimization and developmental impacts in terms of understanding their ability to disclose—effects that need to be understood within a developmental context, especially for designing appropriate interventions for disclosure at critical transitions from early childhood through to adolescence and into adulthood. In addition, important “turning points” in life may facilitate disclosures. For example, entry into adulthood given that delayed disclosure occurs more often in adulthood. Alaggia (2004, 2005) found that being in a committed relationship or the birth of children acted as facilitators for some survivors to disclose, especially to their spouses. These significant life events, as contributing to disclosures, bear further examination.¶
Summary of barriers and facilitators. Research over the past 15 years continues to uncover barriers to CSA disclosure at a higher frequency than that of facilitators. As stated previously, this might be the result of sampling methods whereby participants who volunteer for disclosure research may have had more negative disclosure experiences, especially since many report delays in disclosure. The following section outlines the major trends in both barriers and facilitators (see Table 2).¶
Barriers. Age and gender were found to contribute to barriers as covered in Theme 3. Disclosures generally increase with age¶
Table 2. Factors Influencing Child Sexual Abuse Disclosures.¶
| Barriers | Facilitators |
|---|---|
| Age: The younger the child victim, the less likely they will purposefully disclose. | Age: Disclosures Increase with age. especially in adulthood. |
| Gender: Males may be less likely to disclose in childhood/adolescence, fear of being seen as homosexual and as a victim, females experience more self blame and anticipation of being blamed and/or not believed | Gender. Slight trend toward females who are older (adolescent) to disclose before adulthood |
| Relationship to perpetrator: If the perpetrator is a family member or in a family like role. disclosure is less likely to happen | Relationship to perpetrator: If the perpetrator is not living with the victim, disclosure rates increase |
| Internal: Shame, self blame, and fear are psychological barriers. In addition, fear of negative consequences on the family and for self safety inhibits disclosure | Dialogical context Opportunities to disclose through discussion. therapeutic relationship, information sessions on sexuality, and sexual abuse prevention programs |
| Family relations: families with a patriarchal structure, rigidly fixed gender roles, dysfunctional communication. other forms of abuse (i.e domestic violence), and isolation inhibit disclosure | Family relations: Supportive parent-child relationship. Involvement of others: Eyewitnesses coming forward and reporting: detection through community members, professionals |
| Environmental and cultural context Lack of discussion about sexuality; passive acceptance that unwanted sexual experiences are inevitable; not wanting to bring shame to the family by admitting sexual abuse; lack of involvement from neighbors. school personnel; and stigma perpetuated by societal perceptions | Environmental and cultural context: Promotion of open discussion of sexuality; community member involvement |
as children gain more developmental capacity, understanding of sexual abuse as victimization, and increased independence. Males are somewhat less likely to disclose, but this is often in interaction with other factors in the environment such as societal attitudes that promote hypermasculinity as desirable, attitudes that perpetuate negative views of boys and men who are victims, and homophobic attitudes (Alaggia, 2010; Easton et al., 2014; Gagnier & Collin-Vezina, 2016).¶
Victims of intrafamilial abuse when the offender is a parent, caregiver, significant family member, or someone in a familylike role are less likely to disclose immediately or at all in childhood/adolescence because of obvious power differentials and dependency needs (Collings et al., 2005; Dumont et al., 2014; Hershkowitz et al., 2005; Kogan, 2004; Leclerc & Wortley, 2015; Paine & Hansen, 2002; Schaeffer et al., 2011).¶
Further, the perpetrator residing with their victim(s) increases the likelihood of no disclosure (Leclerc & Wortley, 2015).¶
Internalized victim-blaming, mechanisms to protect oneself (such as minimizing the impact of the abuse), and developmental immaturity at the onset of abuse constituted internal barriers. Further, shame, self-blame, and fear have been identified as significant factors deterring disclosure (Collin-Vezina et al., 2015; Crisma et al., 2004; Goodman-Brown et al., 2003; Hunter, 2011; Kogan, 2004; McElvaney & Culhane, 2015; McElvaney et al., 2014). However, aspects of shame, self-blame and fear, and have not been fully explored in research. Since these are strong predictors of disclosure suppression, they bear further examination in future research to understand more fully how they operate in disclosure processes.¶
In terms of interpersonal and environmental factors, family dynamics can play a part in deterring disclosure. As previously mentioned, families characterized by rigidly defined gender roles, patriarchal attitudes that perpetuate power imbalances between men and women, parents and children, presence of other forms of child abuse and/or domestic violence, chaotic family structure, dysfunctional communication, and social isolation have been found to suppress disclosure (Alaggia & Kirshenbaum, 2005; Collin-Vezina et al., 2015; Fontes & Plummer, 2010). In regard to broader environmental factors, disclosure can be hindered when involved and supportive community members are not available, or not trained in sensitive responses, or when child victims anticipate not being believed by neighbors and other people outside the family (Alaggia, 2010; Collin-Vezina et al., 2015). Further, barriers in relation to the social world were identified as stigmatization, the negative labeling of sexual abuse victims, and taboos surrounding sexuality and talking about sex as driven by cultural norms (Collin-Vezina et al., 2015; Fontes & Plummer, 2010).¶
Identification of cultural barriers is important recent contribution to understanding disclosure processes—and in particular to the obstacles. Findings related to cultural barriers included themes of children’s voices not being heard leading to silencing, the normalization of the sexualization and objectification of girls and women, and the perpetuation of hypermasculinity in men—all acting as barriers in terms of stigma to disclosure (Alaggia, 2005, 2010; Easton et al., 2014). Brazelton (2015) similarly found that lack of discussions about sex, young age at the onset of sexual abuse, therefore not having the language to express what was happening to them, and preserving the family good name by not talking about abuse in the family were also barriers to disclosure.¶
Finally, it may be the case that more barriers continue to be identified over facilitators of CSA disclosure perhaps because of the methods employed in studies—particularly those drawing on adult populations who delayed disclosure. These samples may not be representative of the overall population of CSA victims, since they may have had more negative disclosure experiences, consequently more readily identifying barriers. On the other hand, these findings may speak to the actual imbalance between facilitating factors and barriers for disclosure, the latter carrying more weight in the victims/survivors’ experiences, thus, explaining the high rates of disclosures delayed until adulthood.¶
Facilitators. Although fewer disclosure facilitators are identified in this review, very important facilitators were nonetheless uncovered—ones that should be noted for professionals in this field of practice. Internal factors that facilitate disclosures include symptoms that become unbearable, getting older with increased developmental efficacy, and realizing that an offence was committed (Collin-Vezina et al., 2015; Crisma et al., 2004; Easton, 2013; Hershkowitz et al. 2007; McElavaney, Greene, & Hogan, 2014; Schaeffer et al., 2011). Circumstantial facilitators are those where the child discloses because there has been evidence provided, eye-witnessing has occurred, and a report has been made. Environmental factors include settings that provide opportunities such as counseling, interviews, information sessions and educational forumsAvorIcshops, and prevention programs for children and youth to disclose.¶
To elaborate, dialogical contexts about CSA for children and youth can provide opportunities for discussion that may facilitate disclosures (Jensen et al., 2005). The research shows creating open dialogue in relationship contexts, to offset the power and influence of the perpetrator, can facilitate earlier disclosure. Among disclosure facilitators is being asked about abuse and given the opportunity to “tell” (McElavaney et al., 2014); workshops on abuse and sexual abuse, in particular, can facilitate disclosures (Ungar et al., 2009b); and using culturally sensitive probes and questions (Fontes & Plummer, 2010). In Gagnier and Collin-Vezina’s (2016) study, positive disclosure experiences were described by participants as those where they felt that they had been listened to, were safe, were believed, and were not judged by the person they disclosed to. Further, family members and friends (peers) of the child victim can act as key supports to creating an open relational context and fostering positive responses (Jensen et al., 2005; Priebe & Svedin, 2008; Schonbucher et al., 2012; Ungar et al., 20096). In particular, as children grow older, they are more likely to disclose to a peer, as shown in a number of studies, and this is an important reality for counselors and educators to be aware of (Dumont et al., 2014; Kogan, 2004; Sclainbucher et al., 2012; Ungar et al., 2009b).¶
Discussion¶
Through examination of 33 studies published since the year 2000, this review identified five distinct themes regarding CSA disclosure: (1) Disclosure is best viewed as an iterative, interactive process rather than a discrete event done within a relational context; (2) contemporary models reflect a social—ecological, person-in-environment framework for understanding the complex interplay of individual, familial, contextual, and cultural factors involved in CSA disclosure;¶
(3) age and gender are significant disclosure factors; (4) there is a lack of a life-course perspective; and (5) barriers to disclosure continue to outweigh facilitators. Based on these themes, a number of conclusions are drawn from this review. First, disclosure as a process is emphasized throughout contemporary research. Advances have been made in understanding these complex processes. However, the disclosure process over time—for example, how the first detection of CSA or attempts to disclose in childhood impact later disclosures—are not well understood. This is the result of the absence of a cohesive lifecourse perspective in investigations, although age consistently surfaces as significantly influencing CSA disclosure. Using a life-course perspective through the use of longitudinal studies is recommended.¶
The use of varied methodological designs, depending on the developmental stage of the victims/survivors, influences the data generated and subsequent findings. For example, most studies on children and youth are based on file reviews of cases that have been brought to the attention of authorities, or surveys, with only a few studies using interviewing of younger children. Therefore, there is less information available on process issues with children and youth. In contrast, research on adult populations largely favors the use of qualitative interview methods for retrospective inquiry producing important process findings. In addition, investigations have not yet captured the disclosure experiences of adults in the “emerging adult” stage given that adult studies have failed to recognized that the age range of 18-24, which is now considered a developmental phase defined by neurobiological developmental uniqueness. As well, late adulthood has not been given attention as shown by the absence of participants representing this age-group in current research (70+). With a swelling geriatric population in North America, issues of historic CSA can be expected to surface and, with that, new disclosures. This trend is also anticipated due to attitudinal shifts that have presumably occurred over the last two generations about revealing such traumas and changing views about discussing sexual victimization.¶
Interview guides used in a number of studies intentionally probed for facilitators, producing notable findings. For example, one such finding focuses on the importance of creating a contextually supportive environment to promote disclosure across the life course. These include developing therapeutic relational contexts for disclosure by providing information about sexuality, sexual abuse, prevention programming, and by asking directly. Disclosures to professionals are positive outcomes of how therapeutic contexts work; however, for forensic purposes prompting such disclosures would be viewed as problematic in legal settings, seriously compromising testimonies for trial proceedings. This is one example that speaks to the structural barriers victims and survivors run up against time and time again. Facilitators that show evidence to promote disclosure in one domain (therapeutic) are seen to work against CSA survivors in another domain—such as legal settings when perpetrators face prosecution. Defense attorneys will use this as evidence that the disclosure was prompted, and therefore the disclosure is potentially seen as not credible. Broadcasting of the frequency of acquitted cases or rulings in favor of the perpetrator through media outlets, often sensationalized, become a further compounding barrier. Given the review findings, we conclude that barriers and facilitators to CSA disclosures are nuanced and clearly embedded within intrapersonal, interpersonal, environmental, contextual, and cultural domains—often interlocked in complex ways.¶
Limitations¶
Although comprehensive in nature with its life-course coverage, this review may be limited by its qualitative, thematic focus rather than providing an evaluative, quantitative accounting of CSA disclosures. However, because of the recent focus on disclosure processes, the authors chose a suitably compatible approach—qualitative in nature. As well, a traditional checklist approach in rating the studies was not employed for interrater reliability, since two of the authors hold expertise in CSA disclosure research and are well versed with the literature. This expertise, and through closely following a systematic review framework (Kiteley & Stogdon, 2014), assures that a thorough adjudication of the research literature was completed.¶
Implications for Research and Practice¶
These review findings have implications that can be useful in guiding future research and practice:¶
- Solid strides are being made in the use of a social—ecological framework to underpin investigations in the CSA disclosure investigations. Research efforts and practice considerations should continue in this vein. Investigating environmental factors and contextual and cultural forces is understudied, necessitating more research in these areas to more fully fill out understanding of CSA disclosure from a social—ecological perspective.
- There is good evidence that CSA disclosures are more likely to occur in a dialogical context—formal helping relationships but as well as other relationships such as peers and trusted adults. Providing information and education on topics of sexuality in general, and sexual abuse specifically, can help children and youth to disclose. Raising awareness and prevention programs can promote disclosures of sexual violence committed against children and youth.
- Goals of therapeutically supported disclosures (i.e., through therapy) may need to take precedence over forensic approaches, if well-being of child victims and adult survivors is to be made paramount. Legal processes may act to facilitate disclosures but can also act as barriers because of the negative outcomes experienced in the court process.
- Practitioners need to keep in mind that the legal system is lagging far behind in knowledge uptake of recent evidence on CSA disclosures so that victims and
survivors continue to be systemically and structurally disadvantaged in legal proceedings.¶
- Health-care practitioners (i.e., child abuse pediatricians, family practice doctors, clinical nurse specialists, and public health nurses) should be made aware of the evidence in the CSA disclosure literature to create environments for facilitating therapeutic disclosures.
- Given that age is a stable predictor of disclosure of CSA, more studies are needed that make use of a life-course perspective. More longitudinal studies are needed to better identify trends over different life stages.
- The emerging young adult as a developmental age group needs specific investigation. Neuroscience research has established that ages 18-24 is a distinct developmental phase. Late adulthood is another life stage that deserves to be researched.
- Gender needs to be more fully investigated in relation to impact on disclosure. Awareness that boys and girls have unique challenges and barriers in disclosing CSA should be paramount for practitioners.
- Intervention planning should take note that disclosures increase when perpetrators no longer reside with victims, and this finding should be heeded by policy and law makers.
- Shame, self-blame, and fear are intrapersonal factors that persistently emerge as barriers to CSA disclosures and warrant more research to understand how to redress these barriers for earlier disclosures.
Conclusion¶
There are still a substantial number of children and youth who are subjected to sexual abuse, despite preventative efforts. Just as concerning is the fact that many victims continue to suffer in silence as evidenced by the high numbers of delayed disclosure. These hidden cases should not be overlooked, and these victims should not be forgotten. Despite significant progress in bringing the issue of CSA to the forefront, improving facilitation of disclosure and increasing positive influences on disclosure processes are still critical in order to protect current and future generations of children and youth from the grave effects of sexual violence. Further, the focus should not be simply on strengthening and shoring up intrapersonal resources of victims to disclose but rather to change environmental conditions to create a more supportive and safer context for CSA victims and survivors to disclose.¶
Declaration of Conflicting Interests¶
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.¶
Funding¶
The author(s) received no financial support for the research. author ship, and/or publication of this article.¶
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Author Biographies¶
Ramona Alaggia, MSW, PhD, is an associate professor in social work and the Factor Inwentash Chair in Children’s Mental Health at the University of Toronto. Iler teaching and research focuses on gender and violence, sexual abuse disclosures, domestic violence exposure, and resilience processes.¶
Delphine Collin-Vezina, PhD, is an associate professor for School of Social Work, McGill University and director for Centre for Research on Children and Families. She holds the Nicolas Steinmetz and Gilles Julien Chair in Social Pediatrics in Community and the Canada Research Chair (Tier II) in Child Welfare. Her work focuses on research and clinical topics related to child maltreatment, child sexual abuse, and trauma.¶
Rusan Lateef, MSW, is a social worker employed in the criminal justice system with adult male offenders in Ontario, Canada. She specializes in the intersection of health and mental health, child sexual abuse disclosures, and she is a researcher on the “Make Resilience Matter” project examining childhood exposure to domestic violence with Dr. Alaggia at the Factor Inwentash Faculty of Social Work, University of Toronto.¶
Child Abuse Review Vol. 24: 159-169 (2015) Published online 9 May 2015 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/car.2280¶
Disclosure of Child Sexual Abuse: Delays, Non-disclosure and Partial Disclosure. What the Research Tells Us and Implications for Practice¶
This paper reviews the research on disclosure of child sexual abuse with specific reference to delays in disclosing, non-disclosure and partial disclosure of experiences of child sexual abuse. Findings from large-scale national probability studies highlight the prevalence of both non-disclosure and delays in disclosure, while findings from small-scale qualitative studies portray the complexity, diversity and individuality of experiences. The possible explanations regarding why children are reluctant to disclose such experiences have significant implications for addressing the issue of child sexual abuse from the perspectives of child protection, legal and therapeutic professionals. The importance of understanding the dynamics of disclosure, in particular the needs of young people to maintain control over the disclosure process, the important role that peers play in this process, the responses of adults in both informal and formal networks, and the opportunities to tell, is key to helping young people speak more promptly about their experiences of sexual abuse. Copyright O 2013 John Wiley & Sons, Ltd.¶
KEY PRACTITIONER MESSAGES:¶
- Children typically delay disclosing experiences of abuse.
- Asking children questions about their wellbeing gives them the opportunity to tell when they are ready.
- The challenge is to find the right questions at the right time.
- Peers can be the right people to ask these questions.
- Adolescents need to know about how to ask and what to do if someone tells.
KEY WORDS: child sex abuse; disclosure; research to practice¶
A n issue of increasing concern in recent years is the phenomenon of delayed disclosure of childhood sexual abuse and the need to understand the process of how children and adults disclose their experiences of child sexual abuse, given the implications for child protection, social justice and¶
•Correspondence to: Rosaleen McElvaney. School of Nursing and Human Sciences. Dublin City University. Glasnevin, Dublin 9. Ireland. E-mail: rosaleen.mcelvaneygdcu.ie¶
Copyright © 2013 John Wiley & Sons, Ltd. Accepted: 17 February 2013¶
Rosaleen McElvaney¶
School of Nursing and Human Sciences. Dublin City University, Dublin. Ireland¶
`The importance of understanding the dynamics of disclosure’¶
‘Adolescents need to know about how to ask and what to do if someone tells’¶
160 McElvaney¶
`This paper reviews the research on disclosure patterns of childhood sexual abuse’¶
‘Most people who experience sexual abuse in childhood do not disclose this abuse until adulthood’¶
mental health outcomes. This paper reviews the research on disclosure patterns of childhood sexual abuse, specifically delays in disclosure, non-disclosure (as evident through adult retrospective studies) and partial disclosures, and discusses implications for practice. Literature searches of the online databases PSYCINFO and Social Sciences Citation Index, in addition to manual searches of texts published since 2000, were conducted using the search terms ‘child sexual abuse’, ‘sex abuse’ and ‘disclosure’.¶
The research to date on disclosure patterns is based on two sampling methodologies — studies of adults reporting retrospective experiences and studies of children. The former group of studies has the benefit of drawing on large-scale national probability samples which can be considered to be representative of the general population. The latter group with some small exceptions (predominantly adolescent studies) uses samples of young people who have disclosed sexual abuse but would not be considered as representative of all children who have been abused:¶
‘children who decide to tell someone about being sexually abused and whose cases therefore come to court are not representative of sexually abused children in general’ (Olafson and Lederman, 2006, p. 29).¶
Patterns of Disclosure: Delays and Non-disclosure¶
There is consensus in the research literature that most people who experience sexual abuse in childhood do not disclose this abuse until adulthood, and when disclosure does occur in childhood, significant delays are common. Table 1 summarises two large-scale studies to highlight the extent of delays in disclosure and the percentage of those who did not disclose to anyone prior to the study.¶
Kogan (2004) examined the timing of disclosure of unwanted sexual experiences in childhood or adolescence in a sub-sample (n = 263 adolescent women, aged 12 to 17) of the National Survey of Adolescents (Kilpatrick and Saunders, 1995) in the USA — a nationally representative study. Kogan’s results can be summarised as follows: immediate disclosure (within 1 month) 43 per cent, delayed disclosure (less than 1 year) 31 per cent and non-disclosure (disclosed only during the survey) 26 per cent. Smith and colleagues (2000) examined a sub-sample (n = 288) of the National Women’s Study in the USA (Resnick a al., 1993, cited in Smith et at, 2000) who had reported a childhood rape prior to the age of 18. Smith el al.’s findings can be summarised as follows: immediate disclosure (within 1 month) 27 per cent, delayed disclosure (more than a year) 58 per cent and non-disclosure (survey only) 28 per cent. Those who had never disclosed prior to the survey constitute comparable proportions in these two studies while the rates for immediate¶
Table I. Panerns of disclosure delay and non-disclosure¶
| Kogan (2004) (n 263 adolescents) | Smith a a). (2000) (n 288 adults) | |
|---|---|---|
| Told within 24 hours | 24% | 18% |
| Told within 1 month | 19% | 9% |
| Told within 1 year | 12% | 11% |
| Delayed telling more than I year | 19% | 47% |
| Never told before survey | 26% | 28% |
DOt 10.1002/ear¶
disclosure are higher in the adolescent study than in the adult study, a reassuring finding given the increased awareness of sexual abuse in society during the past 20 years.¶
Goodman-Brown and colleagues (2003) examined USA district attorney files of 218 children. Their categories were slightly different from the previous two studies but in summary, immediate disclosers (within 1 month) constituted 64 per cent of the sample while 29 per cent disclosed within six months. This study is unusual insofar as the sample studied had reported their experience of abuse to the authorities and a prosecution was in progress. Goodman-Brown et at also pointed out that families who participated in this study were more likely to represent those children who experienced abuse by someone outside the family. Research has found that delays in disclosure are longer for those abused within the family and Lindblad, 2002; Goodman-Brown et at, 2003; Kogan, 2004; Hershkowitz a at, 2005). Therefore, children who disclose more promptly may be overrepresented in legal samples.¶
In Sweden, Priebe and Svedin (2008) conducted a national survey of 4339 adolescents, of whom 1962 reported some form of sexual abuse (65% of girls and 23% of boys). Details of the time lapse in disclosing were not available from this study. However, of those who had disclosed and answered the questions on disclosure (n = 1493), 59.5 per cent had told no-one of their experiences prior to the survey. Of those who did disclose, 80.5 per cent mentioned a ‘friend of my own age’ as the only person who they had told. In this study, 6.8 per cent had reported their experiences to the social authorities or police. A further Swedish study of 122 women who had experienced childhood sexual abuse (Jonson and Lindblad, 2004) found that 32 per cent disclosed during childhood (before the age of 18) while the majority told in adulthood (68%). The delay was up to 49 years, with an average of 21 years (SD = 12.9). Of those who told in childhood, 59 per cent told only one person. In Ireland, the SAVI study (n = 3118, McGee et al., 2002) found that 47 per cent of those respondents who had experienced some form of sexual assault prior to age 17 had told no-one of this experience until the survey. McElvaney (2002) investigated delay in a legal sample of ten adults who had made formal complaints of childhood sexual abuse in Ireland and found delays ranging from 20 years to 50 years.¶
Studies of children in the context of forensic/investigative interviews where children are interviewed by professionals due to concerns that the child has been sexually abused also point to high non-disclosure rates, particularly striking in cases where there is corroborative evidence that abuse has occurred — medical evidence (Lyon, 2007), or confessions from the abuser or videotaped evidence/witness reports ( and Lindblad, 2002). Lyon (2007) reported his findings from a review of studies published between 1965 and 1993 of children diagnosed with gonorrhoea where the average disclosure rate among 579 children was 43 per cent (n = 250). In a study where the evidence for the abuse was available on videotape, children have denied abuse when interviewed by the police and Lindblad, 2002).¶
In summary, significant numbers of children do not disclose experiences of sexual abuse until adulthood and adult survey results suggest that significant¶
The rates for immediate disclosure are lower in the adolescent study than in the adult study’¶
‘Children who disclose more promptly may be overrepresented in legal samples’¶
`Delays ranging from 20 years to 50 years’¶
162 McElvaney¶
`High numbers of respondents disclosing to researchers for the first time’¶
`They found that interviewers behaved differently with the two groups'¶
'A parent described how her teenage son told her over a period of days’¶
proportions of adults have never disclosed such abuse, as evidenced by the high numbers of respondents disclosing to researchers for the first time.¶
Patterns of Disclosure — Partial Disclosure¶
Information on how children disclose over time can be obtained from studies of children who participated in forensic/investigative interviews where children are interviewed by professionals due to concerns that the child has been sexually abused. The issue of partial disclosures was highlighted by earlier studies such as those by DeVoe and Faller (1999) of five- to ten-year olds (i.e. making detailed informal disclosures that were not replicated in formal interviews) and Elliott and Briere (1994) of children aged eight to 15 years (i.e. disclosing only partial information until confronted with external evidence that led to more complete disclosures).¶
More recently, investigators have examined the role of the interviewer and questioning styles in the forensic interview and how this impacts on children’s disclosures and the level of detail provided in interview. Hershkowitz et at (2006) compared tapes of interviews with children who disclosed sexual abuse and those who did not (but about whom there was `substantial’ reason to believe that they had been abused). They found that interviewers behaved differently with the two groups, using different types of prompts with children who presented as somewhat uncooperative, offered fewer details and gave more uninformative responses at the beginning of the interview. It would appear that interviewers responded to less communicative children by increasing the proportion of closed questions which in turn led to children being less forthcoming. Lamb el al. (2002) have found that the use of a protocol that emphasises the use of prompts that elicit free narrative (e.g. ‘tell me about that’) as compared with closed questions (those requiring a yes/no response) has resulted in more detail and more accuracy in children’s accounts.¶
Although few studies exist that examine the phenomenon of disclosure in informal settings (when disclosure is made to a friend or family member), some qualitative studies have described this process. McElvaney (2008) quoted one teenage girl who described hinting to her mother prior to disclosing the experience: ‘I didn’t tell her what happened but I was saying things that made her think it made her think that it happened but I didn’t tell her’ (p. 127). A parent described how her teenage son told her over a period of days, keeping the most difficult parts of the story until last:¶
‘Ile came out with like it came out over two or three days so you know.. _he’d say well I’ve something else to tell you… the bad stuff last… what hun him most and what he’s saying what hurt him most’ (p. 92)¶
And finally, one young person described how she told her social worker:¶
‘I couldn’t tell her most things but I just gave things to her to read… I told her at first I told her bits of it and em then just the others. I finished writing and then I gave them to her… later I told her that it was the father as well.’ (p. 93)¶
This young person had been abused by both a father and son in a family with whom she was staying.¶
Copyright O 2013 John Wiley & Sons, Ltd. Chid Abuse Rev. Vol. 24: 159 169 (2015) 10.1002/ear¶
In reviewing the literature on this subject, London and colleagues (2005) noted, `when children do disclose, it often takes them a long time to do so’ (p. 204).¶
Reasons for Patterns of Delay, Partial Disclosure and Non-disclosure¶
There are many influences on disclosure that have been identified in the research literature to help explain why it is that children delay disclosure, are reluctant to disclose, provide details of their experiences over time or do not disclose at all. Age has been identified as a significant predictor of disclosure in that younger children are less likely to disclose than older children. Children who are abused by a family member are less likely to disclose and more likely to delay disclosure than those abused by someone outside the family (Smith a at, 2000; Goodman-Brown a at, 2003; Kogan, 2004). Children who do disclose during forensic interviews compared to children who do not disclose in such contexts (yet concerns remain that they have been abused) are more likely to have parents (particularly mothers) who are more supportive (Lawson and Chaffin, 1992). In Priebe and Svedin’s (2008) study of young people, parental bonding (positive relationship with parent who was not overprotective) was identified as the most significant predictor of disclosure for both boys and girls. However, close relationships can also act as an inhibitor to disclosure. McElvaney (2008) found that many young people in her study were reluctant to disclose due to concerns of upsetting their parents while others were concerned about the consequences for others of their disclosure. One 13-year-old girl described her concern that if she told, her uncle would go to jail and her small cousins would be left without a father:¶
‘I didn’t want them to grow up with no Dad and just looking at … their other little friends having their Dad holding their hand I felt like I was taking their Dad away from them’ (p. 130)¶
Gender has been found to influence disclosure in that boys appear to be more reluctant to disclose than girls (Goodman-Brown a at, 2003; Hershkowitz a at, 2005; Ungar a al., 2009a). Mental health difficulties on the part of the child have also been found to be relevant, particularly when children experience dissociative symptoms or other post-traumatic stress symptomatology (Priebe and Svedin, 2008).¶
Some studies have found that the severity of abuse (e.g. penetrative abuse) predicts earlier disclosure while other studies have found no relationship between different types of abuse and disclosure timing. Similarly, the relationship between the duration of abuse — one-off incidents of abuse compared with abuse that takes place over a significant period of time — and timely disclosure has been investigated with mixed findings. Fear of the consequences of disclosure has been identified as a predictor of delayed disclosure and this in turn is associated with the age of the child (Goodman-Brown a at, 2003). Older children are more cognitively competent in terms of being able to reflect on and anticipate possible reactions to their disclosure. This can act then as an inhibitor to disclosure, although as noted above, most studies have found that older children are more likely to disclose than younger children. Fears of not being believed have been described by young people as inhibiting their disclosure and these fears are often¶
Copyright © 2013 John Wiley & Sons, Ltd. Child Abuse Rev. Vol. 24: 159 169 (2015)¶
“When children do disclose, it often takes them a long time to do so”¶
`Younger children are less likely to disclose than older children’¶
`Many young people in her study were reluctant to disclose due to concerns of upsetting their parents’¶
`Fear of the consequences of disclosure has been identified as a predictor of delayed disclosure’¶
DOI: 10.1002/car¶
justified. Hershkowitz a at (2007) interviewed children about their initial disclosures prior to formal interview and 50 per cent of the sample (n = 30) reported feeling afraid or ashamed of their parents’ reaction. The authors reported that parents did show a tendency to blame their children and react angrily to the disclosure.¶
Recent research has highlighted the need for children to be asked direct questions to facilitate their disclosure. Of those children who did disclose, significant proportions disclosed following prompts rather than it being initiated by the child (Kogan, 2004). Qualitative studies drawing on interviews with children that focus on the disclosure process are important in investigating the precise circumstances that led to disclosures for children. McElvaney (2008) found that parents’ questioning of children was prompted by their concern about the young person’s emotional distress. On occasion, young people were communicating that something was not right in their world but were not able to articulate this verbally. Signs of psychological distress were, however, evident and questions targeted at the reasons for this distress were identified by McElvaney as a factor that helped young people to tell. Thus, many children may not have told about their experiences of abuse because they were not asked. McGee a al. (2002) followed up a sample of their respondents who had disclosed childhood abuse for the first time in their survey. When asked why they had not disclosed prior to the survey, many respondents noted that it was because they had not been asked. Increasingly, research studies are finding that significant proportions of disclosure have been prompted by questions by caregivers, friends or others in the child’s educational and social milieu that in themselves provide an opportunity for the young person to tell (Jensen et at, 2005; Hershkowitz a at, 2007; McElvaney et al., 2012).¶
Finally, some children need time to tell. Mudaly and Goddard (2006) quote a 13-year-old girl: `she (mother) helped by not making me, not rushing me to get it out, which, um, I think it’s a really stupid idea to make kids get it out A.S.A.P.’ (p. 91).¶
Implications for Practice¶
The consensus in the research literature at the present time is that disclosure is multi-determined, influenced by a complex range of factors that may influence each child in a different way. Large-scale national probability studies confirm that non-disclosure and delays in disclosure are significant problems facing society and in particular for those professionals tasked with safeguarding the wellbeing of children. Children’s fears and anxieties in relation to telling need to be understood and contained by those in their environment so that early disclosure can be encouraged and facilitated.¶
The implications of these findings can be considered in interrelated contexts: the legal context where action can only be taken if the child is able to give a clear, credible account of his/her experiences; child protection and therapeutic contexts where a comprehensive account is required to enable child protection professionals to intervene and where the psychological sequelae can be addressed to minimise the long-term impact of the experiences; and family and community contexts where early disclosure needs to be encouraged, and¶
`Investigating the precise circumstances that led to disclosures for children’¶
`Significant proportions of disclosure have been prompted by questions by caregivers, friends or others’¶
`The implications of these findings can be considered in interrelated contexts’¶
DOI: 10.1002/ear¶
other family issues addressed in the aftermath of disclosure and where peers play an important role.¶
Studies have confirmed the importance of professionals asking children and young people in a sensitive, open manner about possible experiences of abuse using non-leading questioning styles to minimise inaccurate accounts or contaminate children’s narratives. It is clearly important for professionals to remain open to the possibility of abuse and further disclosure. It is equally important for professionals to be able to avoid persisting with questioning those children who are ‘reluctant disclosers’. Similarly, professionals engaged with children in therapeutic work need to be open to the possibility of both initial and further disclosures.¶
Contradiction in witness statements is a well-known feature of false statements and giving additional detail to original formal statements can be interpreted within child protection, therapeutic and legal contexts as a contradiction of an earlier account. Listening to children’s accounts of their experiences of disclosure helps us understand why it is that disclosure can be delayed and that when they do feel ready to tell this is not an ‘all or nothing’ decision. As one young person in Staller and Nelson-Gardell’s (2005) study noted, ‘it’s never finished, never’ p. 1426. This understanding in turn helps us identify those circumstances and reactions that may encourage the child to disclose.¶
The importance of asking children questions, thus giving them an opportunity to tell, has been identified. While parents, teachers and those in daily contact with children are often reluctant to question children, it is clear that many children do not disclose unless given this opportunity. Education and increased awareness are needed on how to question children in an appropriate manner. McElvaney (2008) noted that questions did not need to be about sexual abuse per se, but rather questions prompted by the young person’s psychological distress, asking after the young people’s wellbeing. This questioning in effect acted as an external pressure for the young person to tell his/her secret (McElvaney et al., 2012). In Ungar el at’s (2009a) study of Canadian youth, they found that young people used a range of disclosure strategies ranging from less direct strategies (such as risk-taking behaviours, not talking about the abuse) to direct strategies (such as seeking support from peers, turning to non-professional adult supports, disclosing to formal service providers), representing a process that relied heavily on others to ‘build the bridges between the youth and formal care providers’ (p. 352).¶
The tendency to delay disclosing and the partial nature of many disclosures are not conducive to successful legal investigations and prosecutions. In addition, the knowledge base that exists within the legal sphere is limited if only a percentage of the children who experience sexual abuse engage with this system. The disproportionately high ‘immediate disclosure’ rate found in Goodman-Brown a al.’s (2003) legal sample compared to Kogan’s (2004) community sample raises the question of the representation of delayed disclosers in the legal system. Are children who delay in disclosing less likely to engage with the legal system? Are delays in disclosing contributing to decisions not to prosecute child sexual abuse crimes? In Ireland, the 1990s saw a significant increase in the numbers of complainants coming before the courts reporting experiences of childhood sexual abuse. Many of these cases were referred to the higher courts for judicial review proceedings to establish whether the cases could proceed without prejudicing the accused given the¶
‘Contradiction in witness statements is a well-known feature of false statements’¶
‘Education and increased awareness are needed on how to question children in an appropriate manner’¶
‘Are children who delay in disclosing less likely to engage with the legal system?’¶
DOI: 10.1002/car¶
delay in the complaint being made and giving due regard to the accused’s right to a speedy trial. Psychological expert testimony was sought as part of these proceedings to explain the delay in disclosure in each individual case to enable the courts to adjudicate on whether the delay in reporting was reasonable (see McElvaney, 2002). This legal mechanism provided an opportunity to enhance the knowledge base within the legal profession as to the complexities involved in disclosing and formally reporting experiences of childhood sexual abuse for adults. While one might expect that the legal system would be more sympathetic to children’s difficulties in making disclosures, it may also be the case that the belief that ‘if the child was really sexually abused, why would they not tell?’, as articulated by Summit (1983), still prevails.¶
In addition, concerns that engagement with the legal system will lead to further psychological trauma need to be considered. A prospective longitudinal study conducted by Quas et al. (2005) indicated that the consequences of legal involvement change over the course of development and as a function of the child’s reactions to and experiences during the legal case. The associations between legal involvement and outcomes varied with age. The authors suggested that although younger children may be at increased risk for some adverse outcomes such as mental health problems, older children may be at increased risk for other undesirable sequelae such as the negative attitudes of others toward them. Quas and Goodman’s (2011) recent review notes that older children are more at risk in developing poor mental health outcomes. Thus, as noted earlier, young people’s fears of the consequences of disclosure may well be justified. Raised awareness of both the prevalence of non-disclosure of sexual abuse and the importance of supporting children to disclose may go some way to addressing children’s fears.¶
One interesting finding in recent studies is that many young people who delayed disclosure to an adult had told a friend. McElvaney (2008) and Ungar et al. (2009b) identified peer influence as significant in encouraging disclosure among adolescents. There is some suggestion from the research that regardless of the age at the time of abuse, adolescence may be a ‘critical period’ for disclosure. It may be that targeting adolescents in general (rather than those at risk of abuse) may be a powerful prevention tool in encouraging early disclosure. Evaluations of child abuse prevention programmes have shown significant improvements in the levels of awareness of child abuse in children and young people (Rispers et al., 1997; Zwi el al., 2007). It may be that the increasing trend towards peer disclosure is a by-product of such educational and awareness-raising programmes. There is evidence that public awareness campaigns when implemented as part of a multi-dimensional strategy that involves targeting children, parents and communities (see Lalor and McElvaney, 2010, for a review of child abuse prevention programmes) are an effective tool in the prevention of child abuse.¶
McElvaney et al. (2012) describe the importance for young people of containing the secret of abuse and their need for confidentiality following disclosure as representing an adaptive strategy on the part of the young person to contain the experience and his/her emotional reaction to it. The conflict between wanting/needing to keep the secret and wanting/needing to tell is mediated by what they term the ‘pressure cooker effect’. Young people in their study described influences from within and without that led to a build up of pressure, ultimately leading to disclosure. They suggest that building up the¶
‘Concerns that engagement with the legal system will lead to further psychological trauma need to be considered’¶
‘Many young people who delayed disclosure to an adult had told a friend'¶
'An adaptive strategy on the part of the young person to contain the experience’¶
pressure for young people by providing opportunities to tell may be needed to help young people tell more promptly. However, the lack of control that young people experience following disclosure remains an issue (Ungar et al., 2009b; Quayle a al., 2012). This highlights the need for dissemination of information directly to young people about the legal process, the possible consequences of disclosure, as well as ongoing developments in legal proceedings when young people and their families interface with the legal system.¶
The more recent focus on investigating those strategies that children use in making disclosures rather than solely on identifying bathers to disclosure is perhaps more helpful in informing awareness-raising campaigns and professional interventions. The author is involved in a large-scale review of children’s files in an assessment service to ascertain those factors that helped children tell about their experiences of sexual abuse. A pilot study has suggested that this is an appropriate methodology for gathering data on children’s experiences of informal disclosure, acknowledging the limitations of such an approach. Ungar a al. (2009a) describe the optimal conditions for disclosure as follows: being directly asked about experiences of abuse; having access to someone who will listen, believe and respond appropriately; having knowledge and language about what constitutes abuse and how to access help; having a sense of control over the process of disclosure both in terms of their anonymity (not being identified until they are ready for this) and confidentiality (the right to control who knows); and effective responses by adults both in informal and formal contexts.¶
Ungar etal. (2009b) support recent developments in prevention programmes that target supportive formal and informal caregivers in being better able to detect the possibility of abuse and support disclosures rather than focusing on empowering children themselves in making disclosures. Their findings in relation to the importance of bridge building for young people to access formal supports are supported by Jensen et at’s (2005) emphasis on the dialogical nature of disclosure, and the important role that trusted adults and peers play in the disclosure process through noticing signs of psychological distress and asking young people about their psychological wellbeing (Collings a al., 2005; Jensen et at, 2005; McElvaney et at, 2012). More emphasis is therefore needed on providing opportunities for children and young people to disclose. The challenge for professionals and those who care for children is how to do this in a way that protects children and promotes their wellbeing.¶
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‘More recent focus on investigating those strategies that children use in making disclosures’¶
‘Having a sense of control over the process of disclosure both in terms of their anonymity and confidentiality’¶
Copyright 2013 John Wiley & Sons, Ltd. Child Abuse Rev. Vol. 24: 159 169 (2015) DOI: 10.1002/car¶
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CLINICAL RESEARCH ARTICLE¶
Predictors of delayed disclosure of rape in female adolescents and young adults¶
Iva A. E. Bicanicl ”, Lieve M. Hehenkampl , Elise M. van de Puttee, Arjen J. van Wijk3 and Ad de Jongh3•4¶
‘National Psychotraumacenter for Children and Youth, University Medical Center Utrecht, Utrecht The Netherlands; 2Department of Paediatrics, University Medical Center Utrecht, Utrecht, The Netherlands; 3Department of Behavioral Sciences, ACTA, University of Amsterdam and VU University, Amsterdam, The Netherlands; °School of Health Sciences, Salford University, Manchester, United Kingdom¶
Background: Delayed disclosure of rape has been associated with impaired mental health; it is, therefore, important to understand which factors are associated with disclosure latency. The purpose of this study was to compare various demographics, post rape characteristics, and psychological functioning of early and delayed disclosers (i.e., more than I week post rape) among rape victims, and to determine predictors for delayed disclosure.¶
Methods: Data were collected using a structured interview and validated questionnaires in a sample of 323 help seeking female adolescents and young adults (12 25 years). who were victimized by rape, but had no reported prior chronic child sexual abuse.¶
Results: In 59% of the cases, disclosure occurred within I week. Delayed disclosers were less likely to use medical services and to report to the police than early disclosers. No significant differences were found between delayed and early disclosers in psychological functioning and time to seek professional help. The combination of age category 12 17 years [odds ratio (OR) 2.05, confidence intervals (CI) 1.13 3.73], penetration (OR 2.36, CI 1.25 4.46), and closeness to assailant (OR 2.64, CI 1.52 4.60) contributed significantly to the prediction of delayed disclosure.¶
Conclusion: The results point to the need of targeted interventions that specifically encourage rape victims to disclose early, thereby increasing options for access to health and police services.¶
Keywords: Adolescents; young adults: rape: sexual assault: disclosure; latency to disclosure; posurauniatic stress disorder¶
Responsible Editor: Rita Rosner, KU Eichstaett Ingolstadt. Germany.¶
‘Correspondence to: Iva A. E. Bicanic, National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, P.O. Box 85090, NL 3508 AB Utrecht, The Netherlands, Email: i.a.e.bicanio@rencutrecht.n1¶
For the abstract or full text in other languages, please see Supplementary files under Article Tools’¶
Received: 31 August 2014; Revised: 30 Mardi 2015: Accepted: 13 April 2015; Published: 11 May 2015¶
p revious studies have shown that disclosure of rape to formal agencies, such as police or mental health services, is uncommon (Fisher, Cullen, & Turner, 2000; Wolitzky-Taylor et al., 2011), especially when the rape has been committed on a date or by an acquaintance and involves the victim’s use of drugs and/or alcohol (Resnick et al., 2000; Wolitzky-Taylor et al., 2011). There is evidence to suggest that victims believe that professionals will not be helpful to them because their rape experience does not match stereotypical conceptions of rape, such as involving a stranger, a weapon, and severe injury (Patterson, Greeson, & Campbell, 2009; Resnick et al., 2000). Accordingly, adolescents and young adults, who are more at risk to be victimized by rape than other age¶
groups (De Haas, Van Berlo, Bakker, & Vanwesenbeeck, 2012; Tjaden & Thoennes, 2006), may not receive targeted mental health care and may not report the crime to the police (Ruch, Coyne, & Perrone, 2000).¶
For reasons of mental health and public safety, it is important to understand the potential factors that are related to disclosure. Timing of disclosure may be a crucial factor, as early disclosers are more likely to utilize appropriate medical care and report to the police than delayed disclosers (Ahrens, Stansell, & Jennings, 2010; Ullman & Filipas, 2001). In contrast, adults who wait longer than month to disclose the rape are more likely to suffer from posttraumatic stress disorder (PTSD) and depression compared to early disclosers (Ruggiero et al., 2004).¶
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In addition, adolescents who disclose their rape experience at least I month after the incident took place are found to be at higher risk for major depressive disorder and delinquency (Broman-Fulks et al., 2007) compared to those who disclosed within I month.¶
Victim—assailant relationship is crucial in disclosure latency, with victims being at higher risk for delayed disclosure if there is a close relation with the assailant (Kogan, 2004; Koss, 1988; Rickert, Wiemann, & Vaughan, 2005). In contrast, delayed disclosure is less common in victims of a stereotypical rape, i.e., rape by a stranger including a weapon and injury (Smith et al., 2000). Victims of prior sexual trauma are more likely to postpone disclosure of a subsequent assault than those without prior victimization (Smith et al., 2000; Ullman, 1996). This is in contrast with the findings of Ahrens et al. (2010), who report no difference in rates of prior sexual trauma between early and delayed disclosers. In addition, the victim’s age appears to be an important variable in predicting disclosure. Evidence suggests that young children are at higher risk for delayed disclosure than adolescents (Kogan, 2004; Schonbucher, Maier, Mohler-Kuo, Schnyder, & Landolt, 2012). Thus, various rape and victim-related characteristics have been found to be associated with timing of disclosure.¶
The majority of the aforementioned studies included college and adult female rape victims. It is important to examine rape disclosure latency in an age and sex group that is most at risk for rape victimization. There is only one prior quantitative study in adolescents (those aged 12-17 years) that identified factors that might influence disclosure latency (Kogan, 2004). He found that identity of the assailant, a familial relationship with the assailant, and a history of drug abuse in the household were related to the timing of disclosure. The results suggested that a familial relationship with the assailant will postpone disclosure, whereas a history of drug abuse in the household, albeit this seems counterintuitive, makes prompt disclosure more likely. This study had some limitations, including the fact that the interviews were conducted by telephone and that the description of the relationship with the assailant was limited. Therefore, in the present study, we investigated a sample of female adolescent and young adult victims of rape who were admitted to a specialized mental health centre for victims of sexual assault. The first aim of this study was to compare demographics, post-rape characteristics, and psychological functioning between early and delayed disclosers in this group. The second aim, based on the exploratory findings of Kogan (2004), was to determine the predictors for delayed disclosure in adolescents and young adults, including age, prior trauma, and victim—assailant relationship using logistic regression analyses. Insight into the predictors for delayed disclosure for adolescents and young adults may reveal not only potential causal mechanisms but also possible targets for interventions that increase victims’ opportunities to receive timely post-rape services.¶
Methods¶
Subjects and data collection¶
Rape was defined as “an event that occurred without the victim’s consent that involved the use or threat of force in vaginal, anal, or oral intercourse” (Tjaden & Thoennes, 2006). The definition includes both attempted and completed rape; the term “completed” referring to vaginal, oral, anal, or multiple penetrations. Victims who disclosed within 1 week were defined as “early disclosers,” whereas those who disclosed at least after 1 week were defined as “delayed disclosers.” This dichotomization of the variable “disclosure latency” was based on the study of Ahrens et al. (2010) and the national standard criteria for admission to a Rape Centre in the Netherlands, i.e., a maximum of 7 days post-rape.¶
The study was conducted in the Dutch National Psychotrauma Centre, which provides psychological services for rape victims aged 12-25 years and their parents. Between May 2005 and December 2011, the centre received 621 phone calls concerning alleged rape victims from police authorities, mental health services, and selfreferrals. In 178 cases, the phone call did not result in admission at the centre because of age limitations, or motivational reasons. In 108 cases, referrals were made to other institutions because the index trauma was chronic childhood sexual abuse rather than rape in adolescence/ young adulthood. Of the 335 cases admitted to the centre, 12 were not included in this study because of male gender, resulting in a final sample of 323 females with the index trauma being single rape. Referral sources for this final sample included the police (33.7%), mental health services (40.7%). and self-referrals, i.e., victims or parents (25.6%).¶
Procedure¶
During admission, all patients underwent a psychological assessment, consisting of 1) a structured interview for obtaining demographic and post-rape characteristics and 2) self-report questionnaires to obtain information about mental health functioning. Information from the interview was transcribed onto a form designed for this purpose. The following variables were obtained and dichotomized or categorized for the purpose of the study:¶
Demographic and victim characteristics¶
We asked patients about their current age, educational level (lower, middle, or higher), and whether they were of Dutch origin (i.e., in case of having parents born in the Netherlands). Those between 12 and 17 years of age were defined as adolescents and those between 18 and 25 years of age as young adults. We also asked whether the patient was living with their parent(s) (yes/no), and whether the¶
family structure was complete, i.e., whether the biological parents were living together (yes/no). Patients were then asked to confirm the presence of prior negative sexual experiences (yes/no), and whether they had a current sexual relationship (yes/no).¶
Rape characteristics¶
Information about date and time of the rape was obtained to calculate the time since rape at admission. Next, patients were requested to describe the rape. Their response was categorized into use of penetration (yes/no), group rape (yes/no), use of physical violence (yes/no), and use of threats verbally and/or with a weapon (yes/no). Also, information regarding the victim’s relationship to the assailant was obtained. The assailant was defined as a stranger when the victim had never been in contact with the assailant before the rape. Responses were used to form a closeness category (yes in case of family, (boy) friend, or mentor). Patients were also asked about the (estimated) age of the assailant (categorized into 12-17 years or > 18 years), and whether the victim had used alcohol prior to the rape (yes/no).¶
Post-rape characteristics¶
Patients were asked when they first talked about the rape. The response was used to calculate the disclosure time and the help-seeking time. At the end of the interview, patients were asked whether they had reported to the police after the incident (yes/no), and whether they had received any medical care after the incident (yes/no).¶
The study was performed in accordance with the precepts and regulations for research as stated in the Declaration of Helsinki, and the Dutch Medical Research involving Humans Subjects Act concerning scientific research. According to the Ethical Medical Committee of the University Medical Centre Utrecht, this act was not applicable to the present study. Written informed consent was obtained from both patients and parents.¶
Measures¶
Posttraumatic stress¶
The Children’s Responses to Trauma Inventory (CRTI; Alisic, Eland, & Kleber, 2006) was used for participants aged 12-18 years. This is a 34-item questionnaire assessing severity of PTSD symptoms according to DSM-IV. Patients are asked to indicate to what extent a reaction to a traumatic event was present during the past week. Scores range from I to 5, with higher scores indicating more symptomatology. The four subscales: Intrusion, Avoidance, Arousal, and Other Child-Specific Reactions consist of 7, 11, 6, and 10 items, respectively. The reliability of this instrument is good to excellent (Cronbach’s a 0.92 for total score, 0.79 for Intrusion, 0.77 for Avoidance, 0.71 for Arousal; Alisic & Kleber. 2010). For the purpose of the study, only the total score was analysed.¶
Depression¶
Children Depression Inventory (CDI; Kovacs, 1992; Timbremont & Braet, 2002) was used for participants aged 12-17 years of age. The CDI is a 27-item questionnaire, assessing cognitive, affective, and behavioural symptoms of depression. The Dutch CDI has a satisfactory internal consistency, with Cronbach’s a ranging between 0.71 and 0.89 (Timbremont & Braet, 2002).¶
Behavioural problems¶
The Youth Self-Report (YSR; Achenbach & Rescorla, 2001) was used for participants aged 12—I8 years. This questionnaire evaluates the teenager’s perception of behavioural and emotional problems. YSR has shown to be internally reliable (Cronbach’s a’s ranging from 0.71 to 0.95), and convergent and discriminant validity is reported to be satisfactory (Berube & Achenbach, 2006). The YSR includes four broadband scales and nine narrow-band scales to assess behaviour problems. For the purpose of the study, only the total score on behaviour problems was included in the analyses.¶
General psychopathology¶
The Symptom Checklist-90-R (SCL-90-R; Arrindell & Ettema, 1986) was used for participants aged 12-25 years. This is a 90-item self-report inventory to assess psychosocial distress. Patients were instructed to indicate the amount they were bothered by each of the distress symptoms during the preceding week. Patients rated 90 distress symptoms on a five-point Liken scale with being “not at all” and 5 being “extremely.” The statements are assigned to eight dimensions, reflecting various types of psychopathology: anxiety, agoraphobia, depression, somatization, insufficiency, sensitivity, hostility, and insomnia. The Global Severity Index (GSI) can be used as a summary of the test and reflects the severity of all answered statements as a global measure of distress. Cronbach’s a has been found to range from 0.73 to 0.97. For the purpose of the study, only the GSI was analysed.¶
Data analyses¶
To compare demographic and post-rape characteristics between the early and delayed disclosers, chi-square tests were used. To compare multiple continuous psychological scores, MANCOVA was used with “time since trauma” as a covariate to correct for the potential influence of time since trauma.¶
Delayed disclosure was used as a dependent variable. The strength of the univariate associations between each potential risk factor and delayed disclosure was estimated by calculating the odds ratio (OR) along with 95% confidence intervals (95% CI). To determine the strongest risk factors for delayed disclosure, each potential risk¶
factor identified in the univariate analyses with a significant OR (p <0.05) was entered as a predictor variable into the multivariable model, using a stepwise forward logistic regression (LR) analysis with delayed disclosure as the outcome variable. The Hosmer—Lemeshow goodnessof-fit chi-square was used to calculate how well the data fit the model. For all statistical analyses, a p-value of <0.05 was considered statistically significant.¶
All statistical analyses were conducted using SPSS (IBM SPSS Statistics for Windows, Version 20.0, IBM Corp., Armonk, NY).¶
Results¶
Socio-demographic characteristics¶
Socio-demographic characteristics of the sample are presented in Table I. Victims’ age ranged from 12 to 25 years, with a mean age of 16.7 years (SD =2.7) and a median age of 16.1 years. Victims’ mean age at time of rape was 14.3 years (SD =2.7) and a median age of 13.9 years. Penetration occurred in 79.6% of the cases. None of the victims reported prior chronic child sexual abuse. Data about victim—assailant relationship are presented in Table 2. Victims first disclosed after a mean 20.8 weeks (SD =56.8, range 1-624 weeks), although 58.5% of the cases told within 1 week. First disclosure was to a friend (45.8%), parent(s) (17.1%), (ex) boy-friend (9.4%), family member (6.8%), professional (5.8%), or other adult (15.2%). With regard to post-rape services, 53.8% of all victims consulted a doctor for medical care and 51.4% reported to the police. On average, victims were admitted to the centre 59.8 weeks post-rape (SD =93.7, range 1-676). The mean GSI of the rape victims on the SCL-90- R (Al = 209.7, SD = 61.8) was comparable with previously reported data of psychiatric populations [M=203.55, SD = 61.60; 4269) =1.629, p = 0.104] and was substantially¶
Table I. Demographic characteristics of rape victims (N-323) in valid percentages¶
| N | 44 | |
|---|---|---|
| Dutch origin° | 274 | 84.8 |
| Education lever | ||
| Low | 182 | 58.0 |
| Medium | 76 | 24.2 |
| High | 56 | 17.8 |
| Parents divorced | 102 | 31.9 |
| Lives at parental home | 273 | 85.3 |
| Current relationship | 81 | 26.5 |
| Prior negative sex | 46 | 14.8 |
‘Dutch origin was defined as being a child from parents born in the Netherlands: °after 6 years of general primary school, at the age of 12 years. students enter low (4 years). medium (5 years). or high (6 years) secondary education level.¶
| Table 2. Victim assailant relationship (N-323) in valid | ||||
|---|---|---|---|---|
| percentages |
| Stranger | 94 | 29.5 | |
|---|---|---|---|
| (Ex-)Boyfriend | 32 | 10.0 | |
| Friend | 33 | 10.3 | |
| Acquaintance | 61 | 19.1 | |
| Person met during nightlife | 30 | 9.4 | |
| Second-degree relative | 15 | 4.7 | |
| Person seen only once | 15 | 4.7 | |
| Person from school | 14 | 4.4 | |
| Person met on the intemet | 12 | 3.8 | |
| Colleague | 10 | 3.1 | |
| Mentor | 3 | 1.0 |
higher [4269) =24.297, p <0.001] compared to the general population (M=118.28, SD =32.38; Arrindell & Ettema, 1986). For the CDI, mean scores were in the clinical range (M=17.2, SD =4.6) and rape victims had significantly higher mean scores (1(230)=15,923, p <0.001), in comparison to previously reported data of the general population of adolescent girls (Timbremont, Braet, & Roelofs, 2008; M=9.01, SD =6.45).¶
Differences between early and delayed disclosers¶
Fifty-nine percent of the sample consisted of early disclosers (disclosure within I week). No significant differences in demographic characteristics were found between early and delayed disclosers, except that there were more delayed disclosers in the age category 12-17 years compared to the early disclosers group (x2 (1) =6.96; p = 0.008). For rape characteristics, significant differences between groups were found for the use of penetration, with more victims of penetration in the delayed disclosers group compared to the early disclosers group (x2 (I) = 5.37; p =0.02). Also, the delayed disclosers group presented more victims of verbal and/or weapon threats than the early disclosers group (x2 (I)=5.35; p =0.02). Furthermore, among the delayed disclosers more victims identified the assailant as a close person compared to the early disclosers (x2 (I) =10.84; p =0.001). Alcohol was used more often in the early disclosers group compared to the delayed disclosers group (x2 (I) =20.24;p <0.001).¶
With respect to post-rape characteristics, a significantly smaller proportion of the delayed disclosers (15.9%) utilized medical services following the rape compared to the early disclosers (30.3%; z2 (1)=5.32; p =0.02). Similarly, a significantly smaller proportion of the delayed disclosers (14.6%) compared to the early disclosers (34.3%) reported the rape to the police (x2 (I) =16.15; p <0.001). The time since trauma at admission was significantly lower for early disclosers (M=41.1 weeks, SD =79.4) than for delayed disclosers (M =82.9 weeks,¶
SD =103.3: 4314) =4.06, p <0.001). Mean and median time to seek help were 37.7 and 12.0 weeks, respectively. Mean time to seek help did not differ between groups (1(309)=2.54, p <0.48). Excluding outliers (M±3 SD, N = II) did not change the outcome of this analysis. Both early and delayed disclosers scored in the highest level of psychological distress when compared to previously reported norm scores (CRTI, Alisic, Eland, Huijbregts, & Kleber, 2012; CDI, Timbremont et al., 2008; YSR, Achenbach & Rescorla, 2001; SCL-90, Arrindell & Ettema, 1986), but the MANCOVA results showed that when comparing multiple continuous psychological scores, the overall psychological functioning (posttraumatic stress, depression, behavioural problems, and general psychopathology) did not differ significantly between early and delayed disclosers (F(6,I98) = 0.88, p =0.51).¶
Table 3 shows the ORs with 95% Cls for the associations between potential risk factors and delayed disclosure. Delayed disclosers, when compared to early disclosers, were significantly more likely to be in the age category of 12-17 years (OR =2.10), to have experienced rape by a close person (OR = 2.35), to have been threatened verbally and/or with a weapon (OR =1.75), and to have experienced penetration (OR = 1.99). Delayed disclosers were also found less likely to have used alcohol prior to the rape (OR = 0.22). None of the other factors were found to be significant risk factors for delayed disclosure.¶
Predicting delayed disclosure¶
A stepwise forward LR analysis was conducted to predict delayed disclosure, using “age category,” “close assailant,” “use of threats,” and “penetration” as predictors. Victims’ alcohol use was not entered in the analysis because of missing values for 33.4% of the cases. The use of threats was not a significant predictor in the model. A test of the full model against a constant-only model was statistically significant, indicating that the predictors (i.e., age category 12-17 years, close assailant, penetration) reliably distinguished between early and delayed disclosers (2 2 (3) = 23.09, p <0.000). There were no significant interactions between the predictors. Nagelkerke’s R2 of 10.5% suggests only a modest association between the predictors and delayed disclosure, although the model did show an adequate fit to the data (Hosmer-Lemeshow x 2 (4) = 2.77, p <0.60). In total, 62% of the respondents were categorized correctly, when using the three predictors that contributed significantly to the prediction of delayed disclosure: age category 12-17 years (OR 2.05, CI 1.13- 3.73), penetration (OR 2.36, CI 1.25-4.46), and closeness to the assailant (OR 2.64, CI 1.52-4.60).¶
Discussion¶
The results of this study show that, although no differences were found between delayed and early disclosers in psychological functioning and time to seek help,¶
delayed disclosers were less likely to use medical services and to report to the police than early disclosers. Furthermore, this study identified a number of factors related to the timing of rape disclosure, showing that delayed disclosers represented significantly more adolescents than young adults, significantly more victims of penetration than assault, significantly more victims who were threatened than not threatened, and significantly more victims who were close with the assailant.¶
The finding that delayed disclosers are less likely to utilize medical services and report to the police than early disclosers is in line with previous studies in adult women (Ahrens et al., 2010; Ullman, 1996; Ullman & Filipas, 2001). It suggests that disclosure latency is important for public health and safety, as delayed disclosure may not only impede reception of proper medical care, such as treating anogenital injuries and preventing the onset of STDs and unwanted pregnancy (Linden, 2011), but also impede the forensic investigation and apprehension of the assailant (Lacy & Stark, 2013).¶
Three variables were identified that successfully predicted delayed disclosure: age category 12-17 years, penetration, and the assailant being a close person. The finding that the victim’s age significantly predicts disclosure latency is in line with previous research showing that adolescents are at a greater risk for delayed disclosure when compared to their older counterparts (Kogan, 2004; Smith et al., 2000). Adolescents may be less able to overcome the barriers to disclose, including factors such as assailant tactics for maintaining secrecy, stigma that often accompanies rape, and fear that their parents would consequently limit their freedom (Crisma, Bascelli, Paci, & Romito, 2004). Also, as victims approach adulthood, they may possess more information about their rights and options after victimization, and have more possibilities for whom to disclose. In our study, most adolescents disclosed the rape event to peers, in line with prior research (Crisma et al., 2004; Priebe & Svedin, 2008).¶
The use of penetration was found to make victims more likely to postpone disclosure, opposite to the results from Priebe and Svedin (2008), but in line with an older study by Arata (1998), who found that more severe forms of sexual abuse were associated with less disclosure. Penetration may influence disclosure latency through a variety of mechanisms. It could be argued that more severe rape, indicated by the use of penetration, is more likely to be accompanied by extensive coercive use of tactics to maintain the victim’s silence, with fear of reprisal possibly contributing to the finding of delayed disclosure (Kogan, 2004). Also, adolescents may think that social reactions in response to disclosure are more negative in case of completed rape compared to assault.¶
Another factor that seems to make immediate disclosure of rape less likely is closeness to the assailant, as indicated by the assailant being a (boy)friend, family¶
| Early disclosure (N=185) | Delayed disclosure (i.e., >1-week post-rape), N=131 | |||||
|---|---|---|---|---|---|---|
| Demographic and (post-)rape characteristics | OR | 95% CI | ||||
| Age category (years) | ||||||
| 18 25 | 55 | 17.4 | 22 | 7.0 | ||
| 12 17 | 130 | 41.1 | 109 | 34.5 | 2.10 | 1.20 3.65’ |
| Dutch origin | ||||||
| No | 27 | 8.5 | 22 | 7.0 | ||
| Yes | 158 | 50.0 | 109 | 34.5 | 0.85 | 0.46 1.56 |
| Living with parent(s) | ||||||
| No | 29 | 9.2 | 16 | 5.1 | ||
| Yes | 155 | 49.2 | 115 | 36.5 | 1.35 | 0.70 2.59 |
| Complete family structure | ||||||
| No | 58 | 18.4 | 42 | 13.3 | ||
| Yes | 127 | 40.3 | 88 | 27.9 | 0.96 | 0.59 1.55 |
| Current sexual relationship | ||||||
| No | 127 | 411 | 97 | 31.9 | ||
| Yes | 53 | 17.4 | 27 | 8.9 | 0.67 | 0.39 1A4 |
| Prior negative sexual experience(s) | ||||||
| No | 152 | 49.4 | 110 | 35.7 | ||
| Yes | 32 | 10.4 | 14 | 4.5 | 0.61 | 0.31 1.19 |
| Known assailant | ||||||
| No | 56 | 17.7 | 36 | 11.4 | ||
| Yes | 129 | 40.8 | 95 | 30.1 | 1.15 | 0.70 1.88 |
| Close to assailant | ||||||
| No | 150 | 47.6 | 84 | 26.7 | ||
| Yes | 35 | 11.1 | 46 | 14.6 | 2.35 | 1.40 3.9r |
| Group rape | ||||||
| No | 160 | 50.8 | 116 | 36.8 | ||
| Yes | 24 | 7.6 | 15 | 4.8 | 0.86 | 0.43 1.71 |
| Age of assailant (years) | ||||||
| 12 17 | 63 | 20.6 | 54 | 17.6 | ||
| >18 | 117 | 38.2 | 72 | 23.5 | 0.72 | 0.45 1.14 |
| Use of penetration | ||||||
| No | 46 | 14.7 | 19 | 6.1 | ||
| Yes | 136 | 43.5 | 112 | 35.8 | 1.99 | 1.10 3.60’ |
| Use of threats | ||||||
| No | 90 | 31.6 | 48 | 16.8 | ||
| Yes | 76 | 26.7 | 71 | 24.9 | 1.75 | 1.09 2.82’ |
| Use of physical violence | ||||||
| No | 130 | 42.6 | 82 | 26.9 | ||
| Yes | 51 | 16.7 | 42 | 13.8 | 1.31 | 0.80 2.14 |
| Victim% alcohol use |
lithie 3. Demographic and (post )rape characteristics by disclosure time (early vs. delayed disclosers) and odds ratios for delayed disclosure¶
‘p <0.05.¶
Seven participants were dropped from analyses due to missing disclosure time data.¶
No 72 33.5 69 32.1¶
Yes 61 28.4 13 6.0 0.22 0.11 0.44’¶
member, or mentor. This finding is consistent with previous studies showing that the closer the relationship between the victim and assailant, the less likely the young woman was to report this victimization to anyone (Koss, 1988; Rickert et al., 2005; Wolitzky-Taylor et al., 2011). The dynamics of intrafamilial abuse is often proposed as¶
the explanation for delayed or non-disclosure (Kogan, 2004; Smith et al., 2000). In the present study, however, only 5% of the assailants were identified as a family member. Most close relationships referred to (boy)friends, suggesting that a significant percentage of the sample experienced peer-to-peer victimization. This type of victimization is most likely to occur during adolescence, as compared to childhood or young adulthood, and greatly increases the risk of revictimization (Humphrey & White, 2000). Hence, victims of rape by peers may be a target group for interventions promoting early disclosure.¶
Clearly, there are many variables working in tandem to affect the timing of victim’s disclosure. A closer look at the final model, which identified three unique variables that contributed significantly to the prediction of delayed disclosure, can help us to better understand the phenomenon of initial disclosure in adolescents and young adults. Younger adolescent victims who are raped by a close person are more likely to delay disclosure than older victims of attempted rape by a stranger or acquaintance. Perhaps, they struggle with the notion that someone close to them performed such a violent act against them, which confuses them about what might happen in terms of safety if they would disclose (or not). This finding is especially important in the light of the fact that approximately 80% of victims had some sort of relationship with their perpetrator prior to the assault (Basile, Chen, Black, & Saltzman, 2007). With regard to rape types, it would intuitively seem that less severe forms of sexual assault are associated with delayed disclosure and that completed rape would be easier to identify as clearly inappropriate and wrong. Victims of completed rape, however, may be more likely to experience negative psychological reactions, e.g., self-blame and avoidance coping. It is conceivable that they delay their disclosure as a result of rape-induced psychological distress (Starzynski, Ullman, Filipas, & Townsend, 2005), not necessarily the severity of the assault.¶
Although the final model showed acceptable goodness of fit, the percentage of explained variance of delayed disclosure was modest. Thus. there must be other variables predictive of delayed disclosure, such as the assailant’s use of alcohol or weaker support systems, that we did not assess in this study. Besides this limitation, there are other drawbacks of this study that should be mentioned. First, a clinical sample was used with patients reporting high mean levels of psychological distress. This ceiling effect may explain why no differences were found between early and delayed disclosers on psychological functioning, contrary to prior studies (Broman-Fulks et al., 2007; Ruggiero et al., 2004). Second, posttraumatic stress was only assessed for children up to 18 years, and for young adults additional suitable measures were not used. Third, information could have been lost due to dichotomizing the variable disclosure latency. Fourth, results may not be¶
generalizable to all rape victims, because the percentage of victims that consulted a medical professional and reported to the police was higher in our sample than in most studies (Hanson et al., 2003; Resnick et al., 2000; Zinzow, Resnick, Bare, Danielson, & Kilpatrick, 2012). Perhaps, these differences could, at least partially, be explained by the fact that stranger rape, representing 30% of our sample, leads to higher likelihood of help-seeking and police reporting because of its association with higher acknowledgment of victim status (Resnick et al., 2000; Smith et al., 2000). The fact that this is a help-seeking sample is critical for the reasons cited in the discussion, but also because the generalizability of these data to rape victims who never tell anyone—perhaps the group most at risk—simply cannot be known. Besides these limitations, several strengths of the current study need to be noted. One strength is the unique set of adolescents and young adults who presented at a mental health care centre after a single rape event, but who reported no prior chronic sexual abuse in childhood. For 85% of the sample, the index trauma was a first time rape. Moreover, data were collected at a designated referral centre for victims of rape and, therefore, the sample is likely to represent the clinical population of Dutch victims in the age group of 12-25 years.¶
The findings of the current study, suggesting that delayed disclosers are less able to benefit from emergency medical care and evidence collection, have a number of practical implications. One of the strategies to enhance victims’ willingness to disclose within the first week postrape may be sexual education campaigns in school and media, as being uninformed is one of the reasons for them not to disclose (Crisma et al., 2004). Education may include medical information on rape-related pregnancy and STDs, as well as the need for timely emergency contraception and prophylaxis, given that these concerns appear to be facilitators of seeking medical help (Zinzow et al., 2012). Also, practical information about DNA evidence and how to best protect it, e.g., related to showering, clothing, eating, and drinking, may increase the awareness of opportunities in the early-phase post-rape. Moreover, facts about the potential psychological impact of rape, such as PTSD and revictimization, but also information about evidence-based treatments (Elwood et al., 2011; Littleton & Ullman, 2013; McLaughlin et al., 2013), may increase help-seeking behaviour in an early stage. Furthermore, efforts to encourage early disclosure must consider peer-to-peer victimization as a primary factor, as most participants in this study experienced this type of victimization, and may initially not have defined or acknowledged the incident as rape because they rationalize such experiences as normal (Hlavka, 2014), leading to the finding of delayed disclosure.¶
In conclusion, the results of the present study suggest that adolescent victims of rape with penetration by someone close are at increased risk for delayed disclosure, and that delayed disclosers are less likely to use medical services and to report to the police. These findings may assist clinicians and policymakers in understanding rape and help to develop interventions (Unterhitzenberger & Rosner, 2014), specifically targeted to support adolescents and young adults to disclose in an early-phase postrape. Although the vast majority of the participants was living at their parental home, many of the sample did not first disclose to their parents. Therefore, it could be argued that in prevention programs specific attention should be given to the strengthening of the child—parent relationship, to facilitate disclosure to parents (Schonbucher et al., 2012). Next, as victims tend to disclose mostly to peers, prevention programmes may need to aim at teaching adolescents how they can help a peer victim if they become a recipient of disclosure (Schonbucher et al., 2012). In addition, education may increase victims’ willingness to disclose early, thereby increasing opportunities for access to health and police services. It is more likely to reach adolescents with direct, active, and online outreach programs via communication channels that are frequently used by adolescents and young adults particularly social media (i.e., Facebook, Twitter, YouTube, etc.), forums, and mobile apps. Such programmes, wherein adolescents and young adults are being treated as agents and decision makers (Hlavka, 2014), should focus on information concerning what rape actually is—not only the stereotypical idea of rape and what (not) to do in the aftermath of rape especially in the first week postrape. Another way to help improve the support of victims of rape is the implementation of multidisciplinary sexual assault centres (Bicanic, Snetselaar, De Jongh, & Van de Putte, 2014; Bramsen, Elklit, & Nielsen, 2009), as these may be the most suitable places to organize education campaigns and offer integrated post-rape services in one location. Future research should investigate whether the availability of such centres increases the prevalence of police reporting and use of medical care. Moreover, as discussed, previous research concerning the topic of disclosure has focused on the disclosure process, mainly the effect of negative social reactions, and not the latency. In future research, social reactions in relation to disclosure (latency) should be assessed by using the Social Reactions Questionnaire, as well as the victim’s perception of their own experience being defined as rape, as many girls and young women do not report or seek help because they regard sexual violence against them as normal (Hlavka, 2014).¶
Conflict of interest and funding¶
There is no conflict of interest in the present study for any of the authors.¶
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