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Wekerle CIHR Team - Physical and Mental Health of Sexually Abused Boys a Five Year Matched-Control and Cohort Study
- 1. Physical and mental health of sexually abused boys: A five year matched- control and cohort study Isabelle Daigneault, Catherine Bourgeois, Pascale Vézina- Gagnon, Alexane Alie-Poirier, Sonia Dargan, Martine Hébert, & Jean-Yves Frappier Ministère de la Justice du Québec BAVAC
- 2. Université de Montréal Psychology Director TRAJETS Member CRIPCAS & ÉVISSA Université de Montréal Psychology Member TRAJETS, CRIPCAS & ÉVISSA Isabelle Daigneault Principal Investigator Pascale Vézina-Gagnon PhD Student Université de Montréal Psychology Member TRAJETS, CRIPCAS & ÉVISSA Sonia Dargan DPsy Student Université de Montréal Psychology Member TRAJETS, CRIPCAS & EVISSA Catherine Bourgeois PhD Student TRAJETS LAB Alexane Alie Poirier DPsy Student Université de Montréal Psychology Member TRAJETS, CRIPCAS & ÉVISSA
- 3. UQAM Canada research chair Directror ÉVISSA, Member CRIPCAS Université de Montréal Director of peadiatrics Member CRIPCAS & ÉVISSA Martine Hébert Jean-Yves Frappier COLLABORATORS Université de Montréal Canada research chair Member CREF Tonino Esposito Tania Lecomte Université de Montréal Director of Espoir Member of IUSMM & CRIPCAS
- 4. Context CSA is a non-specific risk factor for a variety of mental health problems and psychiatric disorders (Maniglio, 2009; Tyler, 2002), with elevated rates of comorbidity (Brand, King, Olson, Ghaziuddin, & Naylor, 1996; Silverman, Reinherz, & Giaconia, 1996). Risk of mental health problem in adulthood is between 2 and 4 times, and up to 7 times more likely 0 1 CSA is also associated with increased physical health problems in adulthood, such as obesity, poor general health, a greater amount of pain, gastrointestinal and cardio-respiratory problems (Irish, Kobayashi, & Delahanty, 2010) The ratio of female to male victims of childhood sexual abuse that are reported to child protection services and substantiated is 3 : 1 (Daigneault, et al., 2016) ** Male populations are critically understudied ** 0 2 0 3
- 5. Context – Mental and Physical Health – males Mental health of boys : increased odds of eating disorder behaviors, suicidal thoughts and attempts, mood disorder symptoms, behavior problems, as well as personality disorders (odd ratio between 1.3 and 9.5)(Ackard & Neumark-Sztainer, 2003; Garnefski & Arends, 1998; Rhodes et al., 2011; Spataro, 2004) 0 4 Physical health of sexually abused boys compared with general populations : ?0 5
- 6. GOAL To document whether more sexually abused boys will consult their physician and be hospitalized for physical and mental health problems than their peers from the general population over 5 years after a substantiated CSA report
- 7. METHOD 1. Selection All substantiated sexual abuse reports 2001-2010 Link youth center data with Ministry of health data Matched control group – age, gender Physical and mental health (CIM9 et 10) consultations and hospitalizations - 1996 to 2013 2. Data linkage 4. Diagnostics 3. Comparison Indicator Yearly incidence rates post substantiated report 235 222 222 + Excluded participants • Fewer reports • More first reports • Fewer services • Fewer younf offenders • Fewer placed
- 8. Index n 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2001 95 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 11 12 2002 75 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 11 2003 109 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 2004 99 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 2005 131 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 2006 91 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 2007 105 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 2008 76 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 2009 45 -13 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 2010 56 -14 -13 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 Study design
- 9. Study entry n 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2001 95 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 11 12 2002 75 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 11 2003 109 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 2004 99 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 2005 131 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 2006 91 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 2007 105 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 2008 76 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 2009 45 -13 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 2010 56 -14 -13 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 Study design
- 10. Index n 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2001 95 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 11 12 2002 75 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 11 2003 109 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 10 2004 99 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 9 2005 131 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8 2006 91 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 2007 105 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 2008 76 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 2009 45 -13 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 2010 56 -14 -13 -12 -11 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 Study design
- 11. 3% Age at first substantiated CSA report 9.97years 39 13 13 2 Neg PA BP Ab Placed out of home Young offenders30% 34% 25% (n = 222) 75% (n = 660) Boys from the initial sample Other reports after CSA Ran away before or after CSA report Other reports prior to CSA Other interventions 15.02years At the end of the current follow-up PARTICIPANTS 6 7 14 0.4 Neg PA BP Aba 11%
- 12. RESULTS – CONSULTATIONS 2 : No difference in incidence rates 1 : High yearly incidence rate 3 : Significant decrease over five years for both groups Highlights PHYSICAL HEALTH 0% 20% 40% 60% 1 2 3 4 5 Percentage Year post CSA report Case Controls
- 13. RESULTS – HOSPITALIZATIONS 4. Year 4 is an exception, where controls have higher incidence rate 3. On average, incidence rates remain the same over 5 years for both groups 1 : Low yearly incidence rate 2 : Abused boys up to 10 times more likely to be hospitalized at least once Highlights PHYSICAL HEALTH 0% 2% 4% 6% 8% 10% 1 2 3 4 5 Percentage Year post report Case Controls
- 14. RESULTS – CONSULTATIONS 2 : Incidence rate is 3 to 5 times higher in sexually abused boys 1 : Elevated yearly incidence rate for CSA 3 : Inciden rates remain the same over five years for both groups Highlights MENTAL HEALTH 0% 10% 20% 30% 40% 50% 1 2 3 4 5 Percentage Year post report Case Controls
- 15. RESULTS – HOSPITALIZATIONS 1 : Very low yearly incidence rates 2 : Incidence rates are 0% for control group in years 3, 4 and 5 Highlights MENTAL HEALTH 0% 2% 4% 6% 8% 10% 1 2 3 4 5 Percentage Year post report Case Controls
- 16. As expected, sexually abused boys are 3 to 5 times more likely to consult their physician, but we cannot tell whether they are more often hospitalized Sexually abused boys and those from the general population consult their physician at the same rate, but are more often hospitalized, indicating they may wait too long until problems become chronic or severe. CSA prevention may contribute to diminish physical health problems in youth, particularly severe problems that require hospitalizations. Document risk/protection factors to predict physical and mental health problems in childhood, adolescence in order to prevent chronicisation Mental Health Physical Health Prevention Prevention CONCLUSIONS
- 17. Specific problems Determine what are the most frequent problems for boys Mental and physical health associations How do PTSD and depression affect boys’ physical health? Larger youth protection study Broaden study to more youth protection centers and to all maltreatment types – study relationship between health and protection services Study including youth Study using both administrative data and questionnaires/interviews with youth FUTURE PROJECTS 2016 2017 20192018
Editor's Notes
- Laboratoire de recherche sur les trajectoires de santé et de résilience de jeunes agressés sexuellement
- LIMITES cross-sectional or short-term prospective designs samples consisting mostly of adult populations (Miller & Chen, 2010), or at-risk youth (Lanier et al., 2010; Rogosch et al., 2011 No assessment of mental health changes over time
- The goal of the study was to explore whether sexually abused boys had higher rates of medical consultations and hospitalizations for physical and mental health problems than boys from the general population. Against this backdrop, the main objective of this study is to determine if, in the five years following a first substantiated report, sexually abused boys present more mental and physical health problems when compared to those from the general population. We hypothesize that sexually abused boys will present more mental and physical health problems, as indicated by an elevated annual incidence rate of medical consultations and hospitalizations.
- Administrative databases were used to compare medical diagnoses of 222 boys with a substantiated sexual abuse report with those of 222 matched-controls. Results revealed that sexually abused boys were up to five times more likely than those from the general population to consult a physician for mental health problems. With regards to physical health problems, sexually abused boys were as likely as those from the general population to consult a physician, but up to 10 times more likely to be hospitalized.
- Controlling for : Socio-economic status at the time of the first substantiated sexual abuse report (Pampalon & Raymond, 2000), intellectual disability, certain conditions originating from the perinatal period (e.g., low birth weight or premature birth, fetal acidosis, birth trauma), congenital malformations and chromosomal abnormalities (e.g., Down syndrome, cystic fibrosis, fetal alcohol syndrome)
- Ajouter des infos descriptives des jeunes selon les données CJ = voir au bureau les participants avaient en moyenne 20,52 ans (ÉT = 4,65 – MAS = 20,50 et ÉT = 4,70; Mapparié = 20,55 et ÉT = 4,60).
- GLIMMIX SAS. Modèle linéaire mixte général utilisant la fonction de lien logit et la fonction de densité binomiale. Cette approche permet de tenir compte de la dépendance entre les cas et les témoins attribuable à l'appariement, ainsi que de la dépendance entre les observations lors du suivi. Results revealed that sexually abused boys were up to five times more likely than those from the general population to consult a physician for mental health problems. With regards to physical health problems, sexually abused boys were as likely as those from the general population to consult a physician, but up to 10 times more likely to be hospitalized.
- On pourrait ajouter les résultats des variables contrôles si l’on veut, mais moins pertinent ici. SES ne prédit rien, mais congénital et périnatal oui. AS = hospitalisations similaires chez garçons et filles PG = parfois filles, parfois garçons qui sont plus souvent hospitalisés.