Mental Health and Behavioral Outcomes of Sexual and Non-Sexual Abuse Among Child Welfare-Involved Youth

Background and Purpose: Childhood sexual abuse (CSA) is a common problem among child welfare-involved youth. In 2012, CSA constituted almost 10% of substantiated child maltreatment cases, or approximately 52, 000 children. While some scholars have asserted that sexual abuse is the most harmful form of childhood abuse, others have found that non-sexual forms of maltreatment may have more serious mental health and behavioral effects. Previous studies have shown that both CSA and other types of child maltreatment are associated with a number of behavioral and mental health problems. Unfortunately, prior research has not fully examined the outcome differences between child welfare-involved youth with substantiated sexual abuse and youth with other types of maltreatment. The aim of the current study was to explore the differences in mental health and behavioral outcomes between child welfare-involved youth who experience sexual abuse and youth who experience other types of maltreatment. 

Methods: This study examined data from Waves 1 and 2 of the second National Survey of Child and Adolescent Well-Being (NSCAW II). NSCAW II sampling weights were applied in analyses to obtain unbiased estimates of population parameters. The final analysis sample included 447 children, ages 8 to 17.5, who were substantiated for maltreatment, and had the same caregivers at Waves 1 and 2 (n=447).

Descriptive statistical analyses of child and caregiver characteristics were conducted for the sample. Subsequently, nine multivariate ordinary least squares regression models were estimated to examine the relationship between sexual abuse and three child outcomes: internalizing behaviors, externalizing behaviors, and PTSD. Regression models were estimated with three different analysis approaches: (a) Wave 1 outcomes as dependent variables; (b) Wave 2 outcomes as dependent variables; and (c) Wave 2 outcomes as dependent variables with Wave 1 outcomes included as control variables.

Results: Regression analyses showed no impact of CSA on Wave 1 outcomes. However, at Wave 2, children with a history of CSA had posttraumatic stress scores that were over 6 points higher than those with a history of other types of maltreatment. Further, after controlling for Wave 1 outcomes, sexual abuse was associated with internalizing behavior scores that were about 3.72 points lower, and posttraumatic stress scores that were about 5.21 points higher, than other types of maltreatment.

Conclusions and Implications: Our study found that CSA was associated with significantly elevated symptoms of posttraumatic stress as compared to other types of maltreatment. This finding held after controlling for baseline trauma symptoms and all covariates including race, age, placement type, and caregiver characteristics. In contrast, CSA was not significantly related to an increase in behavioral symptoms after controlling for covariates. This study fills a research gap by examining the mental health and behavioral outcomes of children who enter the child welfare system after age 8 with substantiated sexual abuse and investigating how outcomes differ for youth by maltreatment type. Results of this study support the need for trauma-informed interventions for youth survivors of CSA involved with the child welfare system. Specific recommendations for future research and practice will be offered.