Childhood Sexual Abuse and Long-Term Physical Health in Older Adulthood

Background/purpose: Child sexual abuse (CSA) is associated with a host of negative biopsychosocial effects on survivors in adolescence and early adulthood. More specifically, research has established links between CSA and compromised physical health (e.g., substance use, disordered eating, sexually transmitted diseases) and specific medical diagnoses (e.g., obesity, autoimmune conditions, cardiopulmonary disease). Most studies have been conducted with convenience samples of female survivors in early adulthood. Little is known, however, about the long-term impacts of CSA on survivors’ physical health across the life course and into late adulthood. Based on life course perspective and gender socialization theories, study objectives were to investigate: 1) the relationship between CSA and late-life physical health; 2) potential gender differences in the effects of CSA on physical health; and 3) whether social support moderated the impact of CSA on physical health.

Methods: Our analysis was based on the Wisconsin Longitudinal Study (WLS), a multi-wave, population-based survey of 1957 high school graduates (n = 10,317) and siblings. We analyzed data from the most recent wave (2010-2011). Participants (n = 5,968) were in their early seventies (mean age = 72 years) with even gender distribution (53% female; 47% male). The three dependent variables included: number of diagnosed illnesses (Duke Older Adults Survey measure, 15 items), current physical health symptoms (Patient Health Questionnaire, 25 items), and self-rated health (global subjective assessment, 1 item). Social support was assessed using a 7-item instrument measuring functional support. Missing data were addressed through multiple imputation. For each outcome, several multivariate regression models (ordinary least squares) were conducted. The first model included CSA and an elaborate set of controls, followed by models testing for moderation due to gender and social support.

Results: The rate of CSA in the sample was 5.24%. Consistent with our hypotheses, regression results indicated that CSA was significantly associated with more lifetime diagnosed illnesses (b = 0.43, p < .001), more current physical health symptoms (b = 1.24, p < .001), and poorer self-rated health (b = -0.09, p < .05). Although men reported lower scores on each outcome in the general sample, the effect of CSA on health outcomes did not differ between male and female survivors. The interaction between social support and CSA was not significant for the outcomes.

Conclusion/Implications: Using multiple standardized outcome measures, a population-based, mixed gender sample, and robust controls, this investigation was one of the first studies to establish the far-reaching effects of CSA on physical health for survivors in late adulthood. The study confirmed that CSA compromises physical health for both male and female survivors, an important finding given that CSA is often minimized for boys/men. Results underscore the importance of prevention services (e.g., adaptive coping strategies) and health promotion interventions earlier in the life course for CSA survivors. Gerontological service providers should include CSA in screening and assessment procedures, which can facilitate appropriate treatment services for unresolved, distal trauma. Future research should explore resilience factors can might mitigate the potential threats to physical health from CSA.