Childhood Sexual Abuse and Adult Health and Health Care Access

Background and Purpose: Beyond immediate trauma, extant literature suggests that the consequences of childhood sexual abuse are wide-ranging and long-lasting. Neuroscience literature describes that chronic childhood stress leads to dysregulation of the neuroendocrine immune circuitry. Prior work has measured higher rates of obesity, diabetes, hypertension, and metabolic syndrome in adult survivors of childhood abuse—while controlling for measures of childhood socioeconomic status but with inconsistencies by population. This literature has largely overlooked acute health conditions. At the same time, a small body of descriptive literature shows that childhood sexual abuse was associated with poorer adult labor market outcomes. Thus, adults with histories of childhood sexual abuse may have not only a greater health burden but also less ability to pay for needed care.

The objective of the present study was to examine health and health care access of adult survivors of childhood sexual abuse.

Methods: Data and samples: I utilized the National Longitudinal Study of Adolescent to Adult Health, which recruited a random sample of children aged 11-18 in 1994-1995 from both public and private schools. Outcomes were evaluated in Wave IV during 2008-2009 when participants were 24-34 years old. About 15,000 individuals completed both Wave I and Wave IV interviews. Childhood sexual abuse was defined as contact sexual abuse before age 18, as reported in the Wave III or Wave IV self-interview sections.

Measures and analytic strategy: To study adult health, I examined reports of use of all prescription medications in the past four weeks, by medication class. To study health care access, I examined subjective reports of unmet health care needs in the past 12 months, worse health due to the unmet health care need, and uninsured status. I controlled for demographics, other adverse childhood experiences, and childhood socioeconomic status in regression analyses. I used school fixed effects to parse out observed and unobserved factors of the childhood neighborhood and schooling environment that may influence health and economic welfare. I addressed missing data with multiple imputation.

Results: Survivors of childhood sexual abuse, compared to non-survivors, were 41% more likely to have used psychotherapeutic agents; 81% more likely to have used anxiolytics, sedatives, or hypnotics; and 42% more likely to have used antibiotics in the prior four weeks. Survivors were also more likely to be uninsured, to have had an unmet health care need in the past 12 months, and to report a worsening of health due to the unmet health care need.

Conclusions and Implications: Survivors of childhood sexual abuse had higher rates of using drugs indicated for mental health disorders, sleep disorders, and bacterial infections. In the study context prior to implementation of the Affordable Care Act, survivors of childhood sexual abuse had lower rates of insurance coverage. By identifying a vulnerable population with reduced coverage rates, results might support insurance expansions. The health care delivery system could respond by incorporating screening for child maltreatment into well child visits so that children receive needed care in the moment, which might prevent longer-term health care needs and costs.