Martine Hébert

Risk factors for victimization in romantic relationships of young women: a review of empirical studies and implications for prevention

This article reviews the literature on risk factors for victimization in romantic relationships of adolescent girls and young adult women. The review includes 61 empirical studies published between 1986 and 2006 that have investigated risk factors for sustained psychological, sexual, and physical violence in romantic relationships of young women ages 12 to 24. An ecological approach is used as a conceptual model to review risk factors into four categories: sociodemographic factors, individual factors (personal and interpersonal), environmental factors (family, community, and peers), and contextual factors (linked to the romantic relationship). Methodological limitations of the studies in terms of measurement issues, samples studied, research designs, and underlying conceptual models are discussed. Finally, implications for prevention programming are considered. Recommendations are presented about which clientele should be targeted, which risk factors should be considered, and when programs should be implemented.

Predicting suicide attempts in young adults with histories of childhood abuse

BACKGROUND Although childhood abuse is an important correlate of suicidality, not all individuals who were abused as children attempt suicide. AIMS To identify correlates and moderators of suicide attempts in adults reporting childhood physical abuse, contact sexual abuse, or both. METHOD A French-Canadian, school-based cohort (n=1684) was prospectively followed. RESULTS The identity of the abuser moderated the relationship of abuse frequency and suicide attempts, with individuals abused by their immediate family being at highest risk. Although paternal education exhibited negative associations (OR=0.71, 95% CI 0.58-0.88), several externalising phenotypes had positive associations with suicide attempts: disruptive disorders (OR=3.10, 95% CI 1.05-9.15), conduct problems (OR=1.09, 95% CI 1.01-1.19) and childhood aggression (OR=1.41, 95% CI 1.08-1.83). CONCLUSIONS Characteristics of the abuser and abusive acts may be important additional indicators of risk for suicide attempts. Future research needs to employ developmental approaches to examine the extent and mechanisms by which childhood abuse contributes to the shared variance of suicidality, maladaptive traits and psychopathology.

History of family dysfunction and perpetration of dating violence by adolescent boys: a longitudinal study

PURPOSE To examine whether there is a direct or a mediated association between dysfunctional parental behavior in later childhood and involvement in dating violence in a sample of low socioeconomic-status boys during mid-adolescence. METHODS Subjects were 717 boys who participated in a longitudinal study. Data collected at six time periods, beginning at age 10 years and covering a span of 8 years, were analyzed. Dysfunctional parental behavior patterns were defined as perceived harsh parenting practices, laxness of monitoring, and interparental conflict witnessed by the subject. Perpetrated psychological and physical abuse in dating, measured at ages 16 and 17 years, and delinquency, measured at age 15 years, served as dependent measures. All instruments were self-report questionnaires. Multiple regression analysis was used in data analysis. RESULTS Only two variables contributed independently to dating violence. Boys who perceived laxness of monitoring from their parents in their late childhood and reported antisocial behavior at age 15 years, such as delinquency and substance abuse, were at risk of becoming involved in violent dating relationships at age 16 years. Harsh parenting practices from ages 10 to 12 years were also predictors of dating violence. CONCLUSIONS A direct relationship was found between harsh parenting and antisocial behavior and later dating violence. No support was found for the mediation hypothesis of antisocial behavior, but an indirect influence was noted in association with monitoring.

Prevalence of childhood sexual abuse and timing of disclosure in a representative sample of adults from Quebec.

Objective: Our study sought to explore patterns of disclosure of child sexual abuse (CSA) in a sample of adult men and women. Method: A telephone survey conducted with a representative sample of adults (n = 804) from Quebec assessed the prevalence of CSA and disclosure patterns. Analyses were carried out to determine whether disclosure groups differed in terms of psychological distress and symptoms of posttraumatic stress, and a logistic regression was used to examine factors associated with prompt disclosure. Results: Prevalence of CSA was 22.1% for women and 9.7% for men. About 1 survivor out of 5 had never disclosed the abuse, with men more likely not to have told anyone, than women. Only 21.2% of adults reported prompt disclosure (within a month of the first abusive event), while 57.5% delayed disclosure (more than 5 years after the first episode). CSA victims who never disclosed the abuse and those who delayed disclosure were more likely to obtain scores of psychological distress and posttraumatic stress achieving clinical levels, compared with adults without a history of CSA. In the multivariate analysis, experiencing CSA involving a perpetrator outside the immediate family and being female were factors independently associated with prompt disclosure. Conclusion: A significant number of adult women and men reported experiencing CSA, and most victims attested to either not disclosing or significantly delaying abuse disclosure.

Men's and women's childhood sexual abuse and victimization in adult partner relationships: A study of risk factors

OBJECTIVES (1) Document the prevalence of childhood sexual abuse (CSA), childhood physical assault, psychological, physical and sexual intimate partner violence (IPV) in a nationally representative sample. (2) Assess the predictive value of CSA and other characteristics of the respondents and their current partners as potential risk factors for IPV. (3) Assess factors predicting IPV in adulthood in a subsample of women reporting CSA. METHODS The role of CSA as a risk factor for adult IPV was examined using data from the 1999 Canadian General Social Survey. A national stratified sample of 9170 women and 7823 men with current or previous partners were interviewed by telephone by Statistics Canada. Multiple logistic regressions were used. RESULTS CSA consistently predicted IPV for women and men, although this relationship was weaker for men. Age, current marital status and limitations due to physical or mental condition or chronic illness were also predictors of IPV for men and women. For women reporting CSA, age (being younger) or being in a more recent relationship and being limited due to either physical, mental conditions or chronic illness were predictive of adult victimization. CONCLUSIONS These findings indicate that CSA is associated with a greater risk of IPV beyond sociodemographic risk factors. PRACTICE IMPLICATIONS To prevent IPV in women already at risk because of CSA, education about protective strategies seems important, particularly for women with physical or mental limitations, in the beginning stages of intimate relationships or for women with partners who drink excessively.

Sexual abuse of children under 12 years of age: a review of 511 cases.

In a retrospective study of 511 cases of alleged sexual abuse in children 12 years of age and under, data were analyzed with respect to the victims age, sex, and the type of sexual abuse (intra- or extrafamilial). A total of 85.5% of the victims were female and 14.5% were male with ages ranging from 2 months to 12 years. The mean age of female victims was 6.8 years and that of male victims, 7.4 years. Most victims (68%) presented with histories of single assault by a known perpetrator (78%). Characteristics of abuse were found to be associated with the victims age, sex, and relationship to the assailant. School-age victims were more likely to be abused by an individual outside the family or by a complete stranger. Older victims were also more likely to be involved in severe forms of sexual abuse (penetration, attempted penetration or oral-genital contact), associated with acts of abduction and with reports to the police. Male victims were more likely to be assaulted by a stranger, outside the home environment, and to suffer a more severe form of sexual abuse than female victims. Finally, extrafamilial sexual abuse was distinguished from intrafamilial sexual abuse insofar as it was more often a single episode, occurring outside the home environment, involving an act of abduction and physical force, and being reported to the police.

Proximate effects of a child sexual abuse prevention program in elementary school children.

OBJECTIVE The effects of the sexual child abuse prevention program ESPACE were evaluated by means of a Solomon-type design with first and third grade children. ESPACE is an adaptation of the American Child Assault Prevention Program (CAP). Possible side effects of the program were also examined. METHOD A total of 133 children (64 first-graders and 69 third-graders) participated in the study. Children completed a knowledge questionnaire and a video vignette measure designed to evaluate preventive skills towards abusive and potentially abusive situations. A follow-up measure (2 months) was administered to verify whether knowledge and skills were maintained. RESULTS Results indicated that children participating in the prevention program showed greater preventive knowledge and skills relative to children not participating. Follow-up data showed that knowledge gains were maintained while the preventive skill gains may attenuate. However, while global skill scores decreased between post-test and follow-up, children still showed greater preventive skills at follow-up than before the program. In terms of unanticipated side effects, results revealed that almost half of the parents noted positive reactions following childrens participation in the ESPACE program. Furthermore, the majority of parents did not identify negative reactions in their children following their participation in the workshop. CONCLUSION The findings suggest that the Quebec adaptation of the CAP program was effective in training children in abuse prevention concepts and skills.

Lessons learned from child sexual abuse research: prevalence, outcomes, and preventive strategies

Although child sexual abuse (CSA) is recognized as a serious violation of human well-being and of the law, no community has yet developed mechanisms that ensure that none of their youth will be sexually abused. CSA is, sadly, an international problem of great magnitude that can affect children of all ages, sexes, races, ethnicities, and socioeconomic classes. Upon invitation, this current publication aims at providing a brief overview of a few lessons we have learned from CSA scholarly research as to heighten awareness of mental health professionals on this utmost important and widespread social problem. This overview will focus on the prevalence of CSA, the associated mental health outcomes, and the preventive strategies to prevent CSA from happening in the first place.

Natural history of suicidal behaviors in a population-based sample of young adults.

BACKGROUND Suicidal behaviors in young individuals represent an important public health problem. Understanding their natural history and relationships would therefore be of clinical and research value. In this study, we examined the natural histories of several suicidal behaviors and investigated two conceptual models of suicidality (dimensional and categorical) in the context of adolescent and adult-onset suicide attempts. METHOD Participants were members of a prospectively studied, representative, population-based school cohort followed since age 6 (n = 3017) through mid-adolescence (n = 1715) to their early twenties (n = 1684). Outcome measures included suicidal ideation, attempts and completions. RESULTS Approximately one in 500 individuals died by suicide. About 33% had suicidal ideas and 9.3% made at least one suicide attempt. Over half (4.9%) of the self-reported attempters made their first attempt before age 18. With the exception of current suicidal ideas, non-fatal suicidal behaviors were more prevalent in females. In general, parental and cross-sectional self-reports underestimated suicidality rates. Aikaike (AIC) and Bayesian (BIC) information criteria suggested the ordinal model, and dimensional conceptualization of suicide attempts of different onset age, to be more optimal than its multinomial/categorical counterpart (ordinal: AIC 567.55, BIC 635.67; multinomial: AIC 616.59, BIC 723.83). Both models, nevertheless, identified five common factors of relevance to suicidal diathesis: gender, disruptive disorders, childhood anxiousness and abuse, and suicidal thoughts. CONCLUSIONS Non-fatal suicidal behaviors in adolescents and young adults are more common than suggested by cross-sectional studies and parental reports. The dimensional model may be more useful in explaining the relationship of suicide attempts of different age of onset.

Identifying correlates of suicide attempts in suicidal ideators: a population-based study

BACKGROUND Identification of factors that distinguish between ideators who act on their suicidal thoughts from those who do not is an important clinical and research objective. METHOD We examined correlates of suicide attempts in suicidal ideators, members of a French-Canadian, school-based cohort. Suicidal thoughts were evaluated in adolescence and early adulthood in the total sample of suicidal ideators, who were then stratified into subgroups consisting of persistent ideators, male ideators and female ideators. RESULTS In addition to persistent suicidal ideas [odds ratios (ORs) 2.1-2.8], Axis I psychopathology, female gender and childhood sexual abuse (CSA) were the most consistent correlates of suicide attempts. Externalizing disorders were significant contributors in persistent ideators [drug misuse: OR 2.8, 95% confidence interval (CI) 1.1-6.9] and in male ideators in particular (disruptive disorders: OR 5.9, 95% CI 2.2-16.0). In women, psychiatric co-morbidity also had a significant effect (OR 1.6, 95% CI 1.1-2.1). CSA was of relevance in both women (OR 1.2, 95% CI 1.1-1.4) and persistent ideators (OR 1.3, 95% CI 1.1-1.5). Personality traits showed gender-specific contribution with affective instability (OR 1.1, 95% CI 1.01-1.1) and anxiousness (OR 1.3, 95% CI 1.1-1.7) contributing in men and disruptive aggression (OR 1.1, 95% CI 1.03-1.3) in women. CONCLUSIONS Correlates of suicide attempts in suicidal ideators vary as a function of the persistence of suicidal ideas and gender. This heterogeneity across subgroups of suicidal ideators may be attributed, at least in part, to differences between the sexes, early environmental adversity, maladaptive personality, and psychiatric symptoms. Further exploration and continued prospective follow-up is necessary to examine these possibilities.