This article was originally published by Oregon Capital Chronicle.
A recent study by researchers at Oregon State University found that chronic childhood sexual abuse is more likely to lead to negative outcomes in adults than single instances of trauma.
The findings highlight the importance of screening for chronic trauma, rather than relying on one-time checklist-style assessments, which, for instance, ask how severe was the abuse or who was the abuser to the victim.
Popular assessment tools like the Adverse Childhood Experiences, which consists of a series of questions, could be greatly improved with a few basic follow-up questions about the duration of abuse, according to the study’s lead author, Ashley Schuyler.
“(Adverse Childhood Experiences) is useful, but maybe not the most helpful in identifying the individuals who need the most help.” Schuyler told the Capital Chronicle.
Along with physical and mental health challenges, adults who experienced chronic abuse as children suffer from higher rates of drug abuse, poverty and incarceration. Longer durations of childhood trauma are also linked to higher rates of emotional and physical health problems, sexual dissatisfaction and dysfunction, relationship and marital problems, fair or poor overall health, lower educational attainment, income below the poverty level and a history of incarceration.
This is a key issue in Oregon, which surveys have consistently shown ranks high nationwide in the number of children and adults struggling with mental health issues and low in providing access to treatment. The rate of Oregonians with mental illness – 23.8% – was around 4% higher than the national average of 19.9%, according to a 2021 study by the Kaiser Family Foundation. And the share of Oregonians who reported experiencing anxiety or depression and did not receive counseling or therapy was around 8% higher than the national average, or 34.5% compared to 26.9%.
The OSU study did not break down by state the number of adults who suffered childhood trauma, but nationwide the number is estimated to be around 16 million. Of those, around 10 million adults suffered for “intermediate” or “extreme” durations.
In the study, Schuyler and co-author Joseph Catania examined data from the 1995-1996 National Sexual Health Survey conducted by the Center for AIDS Prevention Studies at the University of California-San Francisco. It’s one of few surveys large enough to be considered representative of the U.S. population, Schuyler said.
Of the 6,537 survey respondents, 8.1% reported experiencing chronic sexual trauma prior to turning 18. Fourteen percent of women surveyed reported experiencing chronic childhood sexual abuse, as did 20 to 25% of gay and bisexual men. Those rates have been confirmed in subsequent studies, Schuyler said.
The OSU paper found that the longer childhood trauma took place, the greater the likelihood of adult survivors seeking help, whether in a health care setting, or informally, by confiding to friends and family, for example. Only 27% of respondents who suffered a single instance of trauma reported seeking help, compared to 42% of people with “intermediate-duration” trauma, i.e., one to three years, and 59% of people with extreme-duration trauma of at least four years.
Public health officials need to work on de-stigmatizing sex-related trauma, Schuyler said. ACEs and other checklist-style screening tools are useful as a jumping-off point, but there needs to be more specialized follow-up care, she said.
“On the health care side, one step at reducing that stigma is better preparing and equipping providers to talk about these issues with patients, to ask the right questions and not wait for the patient to bring it up,” she said. “It can help normalize the idea that these are issues we should talk about; that we have resources available to support you.”
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