Patterns of Sexual Abuse Reporting and Inflammation in Young Adults

Background and Purpose: Child sexual abuse (CSA) is a well-known risk factor for depression, PTSD as well as cardiovascular diseases, all conditions with inflammatory origin. Disclosure, offers an opportunity to mitigate the health compromising effect of CSA because whether formal or informal, CSA disclosure can have a positive effect on survivors’ mental and physical health and can curtail future re-victimization. Because of the delicate nature of CSA however, survivors may deny experiences altogether or disclose CSA and one time point and deny such experiences at later time points. Such inconsistencies may be due to difficulty remembering CSA over time or reflect coping processes that encourage repression, avoidance or re-construction of past histories. With increasing evidence supporting trauma related biological alterations, the cost of inconsistent reporting may manifest in physiologic changes that may differ from both survivors who disclose consistently and non-abused individuals. The purpose of this study is to 1) examine the stability of CSA reporting over two time points and 2) Examine whether patterns of CSA reporting are associated with elevated levels of inflammation (CRP).

Methods: Data come from the National Longitudinal Study of Adolescent to Adult Health. The analytic sample includes young adults who completed in-home interviews at Waves I, III and IV with valid sample weights and valid measures of CRP at Wave IV. The final sample consists of 9,268 young adults.

Measures: The outcome variable, CRP is operationalized as a continuous variable with values ranging from 0.28mg/L to 10mg/L. To approximate normal distribution, CRP was log transformed. We identified four distinct groups of CSA reporting: 1) consistent non-reporters (no CSA), 2) consistent reporters (CSA at both time points), 3) inconsistent reporters: No-Yes and inconsistent reporters: Yes to No. We accounted for risky health behavior (smoking status) physical risk factors (BMI, depressive symptoms, use of anti-inflammatory medications, and demographic characteristics.

Analytic approach: Weighted regression models were used to estimate the effect of disclosure patterns on CRP.

Results: Ninety-two percent were consistent non-reporters of CSA, 2.0% were consistent reporters, 2.9% were inconsistent reporters in that they did not endorse CSA at the first time point but endorsed at the second and 3.1% endorsed CSA at the first time point but appeared to change their minds by the second time point. On average, both groups of inconsistent reporters had higher levels of CRP compared to consistent non-reporters. The effect of consistent reporting on CRP was not significant. After adjusting for young adult and childhood socio-demographic characteristics, inconsistent reporters (Y to N) continued to have higher levels of CRP compared to consistent non-reporters. This effect was fully mediated by health behavior (BMI) in the final model.

Conclusions and Implications: Findings suggest survivors who deny or construct inaccurate memories of traumatic experiences may be at a higher risk for negative health behaviors including over-eating that lead to systemic inflammation and the adverse health outcomes associated with it. Survivors of sexual abuse may be at lower risk of having elevated inflammation if they are able to articulate rather than internalize abuse events.