Tuesday, November 17, 2009

Study Finds Sexually Abused Children in Turkey Exhibit More Psychiatric Disorders at Initial Assessment than Two-Years Later

Prior research indicates that children who have been sexually abused are at risk of developing various negative short and long-term psychological sequelae. However, there is little research on the effects of sexual abuse on children living in non-Western contexts. In this study, Ozbaran et al. (2009) aim to explore the emotional and psychological impact of sexual abuse among a sample of children in Turkey at referral and two years after referral. Over 300 parents and their children (ages 5-16) were referred to the Department of Child and Adolescent Psychiatry at Ege University in Turkey, and 20 parents and their children agreed to participate in the research. At referral, the parent-child pairs (N=20) completed the first evaluation, which included a detailed psychiatric examination of each participant, completion of the Child Behavior Checklist by the mother, and an evaluation of the child’s mental capacity by a clinical psychologist. Over a period of two years, the sample participated in a combination of the following interventions, depending on the child and family’s needs: psychopharmacologic medication, parental support groups, family meetings with social workers, school counseling services, sport and art activities, and outpatient occupational therapy. After two years, the parent and child were asked to return for a follow-up evaluation. The study found that children who were sexually abused had more psychiatric disorders during the first assessment (55%) than during the second-stage evaluation (0%). However, the study also found that there was no statistically significant relationships between psychiatric diagnoses, socio-demographic features, duration of abuse, or abuse type.

The study methodology lacked rigor in that it was not clear that there was a systematized method for conducting the first and second-stage evaluations. However, the implementation of blind psychiatric interview during the second-stage evaluation was strength of the study, because it lessens the likelihood that the therapist’s impressions will be biased. The small sample size (N=20) of the study, ensured that no participants were lost to follow-up. However, the small sample size - and therefore the decreased statistical power - also made it difficult to draw any statistically significant conclusions. The lack of a control group in the study design also made it a challenge to directly demonstrate a causal relationship between sexual abuse and development of a psychiatric diagnosis or behavioral problems. The authors’ statement that the condition of the sexually abused children in their sample improved significantly as a result of time is misleading, because the study design doesn’t discern whether this is attributed to time or to the array of intervention services that the children and their families received during the study period. Lastly, sampling bias may pose a threat to the external validity of the study, as the sample reflected less than 7% of the initial referrals (over 300) to the hospital. This small sample may have characteristics that the general population does not exhibit. In light of these limitations, this study still adds to the sparse literature on the topic of children affected by sexual abuse in non-Western settings and represents an obvious precursor to more rigorous studies.

Ozbaran, B., Erermis, S., Bukusoglu, N., Bildik, T., Tamar, M., Ercan, E.S., Aydin, C., and Cetin, S.K. (2009). Social and emotional outcomes of child sexual abuse: a clinical sample in Turkey. Journal of Interpersonal Violence, 24(9), 1478-1493.

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