Sexual Wellness and Resilience: Trajectories Among Youth with Maltreatment Histories from a National Sample

Background: Research tends to focus on negative outcomes of trauma, childhood maltreatment, and unwanted sexual behaviors. However, resilience theory and research suggest that some youth follow a trajectory of adaptation, avoiding negative outcomes despite experiencing life stressors (resilience), while others follow a trajectory of unrelenting poor functioning following a stressor (chronic), and some demonstrate functional growth (thriving). Models of resilience have yet to be applied to youth sexuality. This bias towards negative outcomes implies that those with trauma histories cannot experience sexual wellness. To counter this deficit-focused discourse, this study uses resilience theory to investigate whether or not traditional (i.e., psychological functioning) trajectories of resilience can be translated into the domain of sexual wellness. We expected youth with maltreatment histories to fall into one of four sexual wellness categories: chronic, survival, resilient, and thriving. 

Method: Classes of sexual wellness spanning early adolescence to young adulthood were identified through latent class growth analysis (Mplus 7.0). The sample (n=1606) consisted of individuals in the National Longitudinal Study of Adolescent Health. To ensure complete and comparable data, individuals were included if they: participated in all four data collection waves; were 13-16 years old and unmarried at Wave I; had a valid Wave IV grand sample weight; and reported childhood maltreatment. Sexual wellness was operationalized as multidimensional, comprised of empirically and theoretically supported domains: safe sexual behaviors, emotional and mental sexual health, and positive sexual self-concept. Multinomial logistic regressions and PROC GLM (SAS 9.3) were used to identify differences based on demographic covariates and engagement in sexual behaviors across classes.

Results: About half of this sample was girls (55.2%), who were about 15 years old (SD = .03) at Wave I and White (65.7%), though racial diversity was present (13.7% black, 11.9% Hispanic, and 8.64% other). Three sexual wellness classes were identified: survival, resilient, and improving. There were no significant differences related to race or SES. However, individuals in the survival class were 3 times more likely to be older compared to the improving and resilient classes. Girls were less likely to be in the survival class compared to the improving class, but about 5 times more likely to be in the improving class compared to the resilient class. Mean level differences in sexual behaviors between classes emerged at Waves I (early adolescence) and II (mid-adolescence). Individuals in the resilient class reported significantly more sexual behaviors than those in the improving class but fewer than those in the survival class. Additionally, those in the survival class reported significantly more sexual behaviors than members of the improving class. By late adolescence and/or young adulthood, these differences were no longer significant.

Conclusion: Findings affirm the applicability of resilience trajectories to youth sexuality and the potential of youth with trauma histories to experience sexual wellness, one component of overall health. Poor sexual outcomes are not necessarily a universal outcome among those experiencing abuse. Results of this study can advance interventions to not only diminish sexual risks, but also promote sexual wellness among youth with maltreatment histories.