Childhood Disclosure of Sexual Abuse and Mental Health Outcomes in Adulthood: Assessing Merits of Early Disclosure and Discussion for Male Survivors

Background: To contain harmful effects of childhood sexual abuse (CSA), many secondary prevention programs encourage children to report the abuse to a trusted adult soon after it happens.  Disclosure is also a key component of several theoretical models of healing and recovery from CSA.  However, empirical evidence on the impact of early disclosure of CSA on long-term mental health of survivors is limited; many existing studies are based on clinical samples with predominantly/exclusively female participants in young adulthood.  Evidence is also mixed on whether early disclosure protects against (or contributes to) symptomatology in adulthood for survivors.  The primary aim of the current study was to examine whether early disclosure (i.e., within one year) and other disclosure-related variables were associated with long-term mental health for men with histories of CSA. 

Methods: Data were collected from a large, non-clinical sample of male survivors (N=487) who were recruited through several national survivor organizations.  Participants ranged in age from 19 to 84 years (mean = 50 years) and completed an anonymous, online survey, which included a standardized, 25-item measure of mental distress (symptom count of anxiety, depression, and somatization).  After generating descriptive and bivariate statistics, hierarchical regression analyses (i.e., ordinary least squares) were sequentially conducted with four models by entering clusters of predictor variables: control variables (e.g., demographic background, childhood environment, levels of adult stressors), CSA characteristics (e.g., duration, penetration, number of abusers), disclosure (disclosed within one year, helpfulness of response), and discussion (e.g., had an in-depth discussion, years until discussion).  Diagnostic tests conducted prior to inferential testing found that assumptions were met for multivariate statistical analyses; there was very little missing data (i.e., < 3%).   

Results: Overall, models explained between 24-28% of the variance in the dependent variable (mental distress).  The final model was significant (F (12, 435) = 15.379, p < 0.001).  Early disclosure (β= -0.117, p = 0.006), helpful response to first disclosure (β = -0.113, p = 0.008), having an in-depth discussion (β = -0.085, p = 0.036), and age (β = -0.212, p < 0.001) were significant protective factors.  Years until in-depth discussion (β = 0.102, p = 0.029) and level of current stressors (β = 0.367, p < 0.001) were also related to mental distress.  None of the CSA severity or race/ethnicity variables reached significance. 

Conclusions and Implications: Results support conventional wisdom underlying secondary prevention programs and theoretical models of recovery; disclosing early (i.e., reporting or telling within one year of CSA) promotes mental health in adulthood for men.  Beyond telling, this investigation was one of the first non-clinical studies of male survivors that found protective effects of other disclosure variables (i.e., helpful response, in-depth discussion) for men’s health.  Public health programs should continue to promote early disclosure for boys; family members and professionals (i.e., child protective workers, clinical providers) should increase opportunities for boys/men to process abuse through in-depth conversations, especially in minority communities with less access to services.  Future research should explore facilitators of disclosure, including what male survivors describe as helpful responses.