Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-18T05:12:21.366Z Has data issue: false hasContentIssue false

Sexual abuse and psychiatric disorder in England: results from the 2007 Adult Psychiatric Morbidity Survey

Published online by Cambridge University Press:  10 June 2010

S. Jonas
Department of Mental Health Sciences, University College London, UK
P. Bebbington*
Department of Mental Health Sciences, University College London, UK
S. McManus
National Centre for Social Research, London, UK
H. Meltzer
Department of Health Sciences, University of Leicester, Leicester General Hospital, UK
R. Jenkins
King's College London, UK
E. Kuipers
King's College London, UK
C. Cooper
Department of Mental Health Sciences, University College London, UK
M. King
Department of Mental Health Sciences, University College London, UK
T. Brugha
Department of Health Sciences, University of Leicester, Leicester General Hospital, UK
*Address for correspondence: Professor P. Bebbington, Department of Mental Health Sciences, UCL, Charles Bell House, 67–73 Riding House Street, LondonW1W 7EJ, UK. (Email:



Evidence is accumulating that child sexual abuse (CSA) is associated with many psychiatric disorders in adulthood. This paper uses the detailed information available from the 2007 Adult Psychiatric Morbidity Survey of England (APMS 2007) to quantify links between CSA and a range of psychiatric conditions.


The prevalence of psychiatric disorder was established in a random sample of the English household population (n=7403), which also provided sociodemographic and experiential information.


We analyzed six types of common mental disorder, alcohol abuse and drug abuse, and people who screened positively for post-traumatic stress disorder (PTSD) and eating disorders. All were strongly and highly significantly associated with CSA, particularly if non-consensual sexual intercourse was involved, for which odds ratios (ORs) ranged from 3.7 to 12.1. These disorders were also related to adult sexual abuse (ASA), although the likelihood of reverse causality is then increased. Revictimization in adulthood was common, and increased the association of CSA with disorder. For several disorders, the relative odds were higher in females but formal tests for moderation by gender were significant only for common mental disorders and only in relation to non-consensual sexual intercourse. The population attributable fraction (PAF) was higher in females in all cases.


The detailed and high-quality data in APMS 2007 provided important confirmation both of the strength of association of CSA with psychiatric disorder and of its relative non-specificity. Our results have major implications at the public health level and the individual level, in particular the need for better recognition and treatment of the sequelae of CSA.

Original Articles
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Anda, RF, Felitti, VJ, Bremner, JD, Walker, JD, Whitfield, C, Perry, BD, Dube, SR, Giles, WH (2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience 256, 174186.CrossRefGoogle ScholarPubMed
Banyard, VL, Williams, LM, Siegel, JA (2001). The long-term mental health consequences of child sexual abuse: an exploratory study of the impact of multiple traumas in a sample of women. Journal of Traumatic Stress 14, 697715.CrossRefGoogle Scholar
Baron, RM, Kenny, DA (1986). The moderator mediator variable distinction in social psychological research – conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology 51, 11731182.CrossRefGoogle ScholarPubMed
Batty, GD, Gale, CR (2009). Impact of resurvey non-response on the associations between baseline risk factors and cardiovascular disease mortality: prospective cohort study. Journal of Epidemiology and Community Health 63, 952955.CrossRefGoogle ScholarPubMed
Bebbington, PE, Bhugra, D, Brugha, T, Farrell, M, Jenkins, R, Lewis, G, Meltzer, H (2004). Psychosis, victimization and childhood disadvantage. Evidence from the Second British National Survey of Psychiatric Morbidity. British Journal of Psychiatry 185, 220226.CrossRefGoogle ScholarPubMed
Bebbington, PE, Cooper, C, Minot, S, Brugha, TS, Jenkins, R, Meltzer, H, Dennis, M (2009). Suicide attempts, gender and sexual abuse: data from the British Psychiatric Morbidity Survey. American Journal of Psychiatry 166, 11351140.CrossRefGoogle ScholarPubMed
Bebbington, PE, Jonas, S, Brugha, T, Meltzer, H, Jenkins, R, Cooper, C, King, M, McManus, S (in press). Child sexual abuse reported by an English National Sample: characteristics and demography. Social Psychiatry and Psychiatric Epidemiology.Google Scholar
Bergman, P, Ahlberg, G, Forsell, Y, Lundberg, I (2010). Non-participation in the second wave of the PART study on mental disorder and its effects on risk estimates. International Journal of Social Psychiatry 56, 119132.CrossRefGoogle Scholar
Brewin, CR, Rose, S, Andrews, B, Green, J, Tata, P, McEvedy, C, Turner, SW, Foa, EB (2002). Brief screening instrument for post-traumatic stress disorder. British Journal of Psychiatry 181, 158162.CrossRefGoogle ScholarPubMed
Bulik, CM, Prescott, CA, Kendler, KS (2001). Features of childhood sexual abuse and the development of psychiatric and substance use disorder. British Journal of Psychiatry 179, 444449.CrossRefGoogle Scholar
Classen, CC, Palesh, OG, Aggarwal, R (2005). Sexual revictimization: a review of the empirical literature. Trauma Violence and Abuse 6, 103129.CrossRefGoogle ScholarPubMed
Cortes, DC, Justicia, FJ (2008). Child sexual abuse coping and long term psychological adjustment. Psicothema 20, 509515.Google Scholar
Coxell, A, King, M, Mezey, G, Gordon, D (1999). Lifetime prevalence, characteristics and associated problems of non-consensual sex in men: a cross sectional survey. British Medical Journal 318, 846850.CrossRefGoogle Scholar
Dinwiddie, S, Heath, AC, Dunne, MP, Bucholz, KK, Madden, PAF, Slutske, WS, Bierut, LJ, Statham, DB, Martin, NG (2000). Early sexual abuse and lifetime psychopathology: a co-twin-control study. Psychological Medicine 30, 4152.CrossRefGoogle ScholarPubMed
Driessen, M, Herrmann, J, Stahl, K, Zwaan, M, Meier, S, Hill, A, Osterheider, M, Petersen, D (2000). Magnetic resonance imaging volumes of the hippocampus and the amygdala in women with borderline personality disorder and early traumatization. Archives of General Psychiatry 57, 11151122.CrossRefGoogle ScholarPubMed
Fergusson, DM, Horwood, LJ, Woodward, LJ (2000). The stability of child abuse reports: a longitudinal study of the reporting behaviour of young adults. Psychological Medicine 30, 529544.CrossRefGoogle ScholarPubMed
Fortier, MA, DeLillo, D, Messman-Moore, TL, Peugh, J, DeNardi, KA, Gaffey, KJ (2009). Severity of child sexual abuse and revictimisation: the mediating role of coping and trauma symptoms. Psychology of Women Quarterly 33, 308320.CrossRefGoogle Scholar
Friedman, S, Smith, L, Fogel, D, Paradis, C, Viswanathan, R, Ackerman, R, Trappler, B (2002). The incidence and influence of early traumatic life events in patients with panic disorder: a comparison with other psychiatric outpatients. Journal of Anxiety Disorders 16, 259272.CrossRefGoogle ScholarPubMed
Gold, SR, Sinclair, BB, Balge, KA (1999). Risk of sexual revictimization: a theoretical model. Aggression and Violent Behavior 4, 457470.CrossRefGoogle Scholar
Heim, C, Newport, DJ, Miller, AH, Nemeroff, CB (2000). Long-term neuroendocrine effects of childhood maltreatment. Journal of the American Medical Association 284, 23212322.Google ScholarPubMed
Holmes, EA, Arntz, A, Smucker, MR (2007). Imagery rescripting in cognitive behaviour therapy: images, treatment techniques and outcomes. Journal of Behavior Therapy and Experimental Psychiatry 38, 297305.CrossRefGoogle Scholar
Janssen, I, Krabbendam, L, Bak, M, Hanssen, M, Vollebergh, W, de Graaf, R, van Os, J (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica 109, 3845.CrossRefGoogle ScholarPubMed
Jenkins, R, Meltzer, H, Bebbington, P, Brugha, T, Farrell, M, McManus, S, Singleton, N (2009). The British Mental Health Survey Programme: achievements and latest findings. Social Psychiatry and Psychiatric Epidemiology 44, 899904.CrossRefGoogle ScholarPubMed
Johns, LC, Cannon, M, Singleton, N, Murray, RM, Farrell, M, Brugha, T, Bebbington, P, Jenkins, R, Meltzer, H (2004). The prevalence and correlates of self-reported psychotic symptoms in the British population. British Journal of Psychiatry 185, 298305.CrossRefGoogle ScholarPubMed
Kamsner, S, McCabe, MP (2000). The relationship between adult psychological adjustment and childhood sexual abuse, childhood physical abuse, and family-of-origin characteristics. Journal of Interpersonal Violence 15, 12431261.CrossRefGoogle Scholar
Kendler, KS, Bulik, CM, Silberg, J, Hettema, JM, Myers, J, Prescott, CA (2000). Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Archives of General Psychiatry 57, 953959.CrossRefGoogle ScholarPubMed
Kendler, KS, Kuhn, JW, Prescott, CA (2004). Childhood sexual abuse, stressful life events and risk for major depression in women. Psychological Medicine 34, 14751482.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions' of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.CrossRefGoogle ScholarPubMed
Kessler, RC, McGonagle, KA, Zhao, SY, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.CrossRefGoogle ScholarPubMed
King, M, Coxell, A, Mezey, G (2002). Sexual molestation of males: associations with psychological disturbance. British Journal of Psychiatry 181, 153157.CrossRefGoogle ScholarPubMed
Kish, L (1965). Survey Sampling. John Wiley and Sons, Inc.: New York.Google Scholar
Koenen, KC, Widom, CS (2009). A prospective study of sex differences in the lifetime risk of posttraumatic stress disorder among abused and neglected children grown up. Journal of Traumatic Stress 22, 566574.CrossRefGoogle ScholarPubMed
Lewis, G, Pelosi, AJ, Araya, R, Dunn, G (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine 22, 465486.CrossRefGoogle ScholarPubMed
Linden, M, Zehner, A (2007). The role of childhood sexual abuse (CSA) in adult cognitive behaviour therapy. Behavioural and Cognitive Psychotherapy 35, 447455.CrossRefGoogle Scholar
MacMillan, HL, Fleming, JE, Streiner, DL, Lin, E, Boyle, MH, Jamieson, E, Duku, EK, Walsh, CA, Wong, MYY, Beardslee, WR (2001). Childhood abuse and lifetime psychopathology in a community sample. American Journal of Psychiatry 158, 18781883.CrossRefGoogle Scholar
Malgady, RG, Rogler, LH, Tryon, WW (1992). Issues of validity in the Diagnostic Interview Schedule. Journal of Psychiatric Research 26, 5967.CrossRefGoogle ScholarPubMed
Mannarino, AP, Cohen, JA (1996). Abuse-related attributions and perceptions, general attributions, and locus of control in sexually abused girls. Journal of Interpersonal Violence 11, 162180.CrossRefGoogle Scholar
May-Chahal, C, Cawson, P (2005). Measuring child maltreatment in the United Kingdom: a study of the prevalence of child abuse and neglect. Child Abuse and Neglect 29, 943–1070.CrossRefGoogle ScholarPubMed
McManus, S, Meltzer, H, Brugha, T, Bebbington, P, Jenkins, R (2009). Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. National Centre for Social Research, London.Google Scholar
Meltzer, H, Gill, B, Petticrew, M, Hinds, K (1995). OPCS Surveys of Psychiatric Morbidity in Great Britain, Report 1: The Prevalence of Psychiatric Morbidity Among Adults Living in Private Households. HMSO: London.Google Scholar
Messman-Moore, TL, Brown, AL, Koelsch, LE (2005). Posttraumatic symptoms and self-dysfunction as consequences and predictors of sexual revictimization. Journal of Traumatic Stress 18, 253261.CrossRefGoogle ScholarPubMed
Messman-Moore, TL, Ward, RM, Brown, AL (2009). Substance use and PTSD symptoms impact the likelihood of rape and revictimization in college women. Journal of Interpersonal Violence 24, 499521.CrossRefGoogle ScholarPubMed
Molnar, BE, Buka, SL, Kessler, RC (2001). Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American Journal of Public Health 91, 753760.Google ScholarPubMed
Morgan, J, Reid, F, Lacey, JH (1999). The SCOFF questionnaire: assessment of a new screening tool for eating disorders. British Medical Journal 319, 14671468.CrossRefGoogle ScholarPubMed
Mullen, PE, Martin, JL, Anderson, JC, Romans, SE, Herbison, GP (1993). Childhood sexual abuse and mental health in adult life. British Journal of Psychiatry 163, 721732.CrossRefGoogle ScholarPubMed
Murthi, M, Espelage, DL (2005). Childhood sexual abuse, social support, and psychological outcomes: a loss framework. Child Abuse and Neglect 29, 12151231.CrossRefGoogle ScholarPubMed
Nelson, EC, Heath, AC, Lynskey, MT, Bucholz, KK, Madden, PAF, Statham, DJ, Martin, NG (2006). Childhood sexual abuse and risks for licit and illicit drug related outcomes: a twin study. Psychological Medicine 36, 14731483.CrossRefGoogle ScholarPubMed
O'Leary, PJ (2009). Men who were sexually abused in childhood: coping strategies and comparisons in psychological functioning. Child Abuse and Neglect 33, 471479.CrossRefGoogle ScholarPubMed
Pereda, N, Guilera, G, Forns, M, Gomez-Benito, J (2009). The prevalence of child sexual abuse in community and student samples: a meta-analysis. Clinical Psychology Review 29, 328338.CrossRefGoogle ScholarPubMed
Polusny, MA, Follette, VM (1995). Long-term correlates of child sexual abuse: theory and review of the empirical literature. Applied and Preventive Psychology 4, 143166.CrossRefGoogle Scholar
Putnam, FW (2003). Ten-year research update review: child sexual abuse. Journal of the American Academy of Child and Adolescent Psychiatry 42, 269278.CrossRefGoogle ScholarPubMed
Read, J, van Os, J, Morrison, AP, Ross, CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica 112, 330350.CrossRefGoogle ScholarPubMed
Romito, P, Gerin, D (2002). Asking patients about violence: a survey of 510 women attending social and health services in Trieste, Italy. Social Science and Medicine 54, 18131824.CrossRefGoogle ScholarPubMed
Saunders, JB, Aasland, OG, Babor, TF, de la Fuente, JR, Grant, M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption – II. Addiction 88, 791804.CrossRefGoogle ScholarPubMed
Singleton, N, Bumpstead, R, O'Brien, M, Lee, A, Meltzer, H (2001). Psychiatric Morbidity Among Adults Living in Private Households, 2000. TSO: London.Google Scholar
Spauwen, J, Krabbendam, L, Lieb, R, Wittchen, HU, van Os, J (2006). Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness. British Journal of Psychiatry 188, 527533.CrossRefGoogle ScholarPubMed
StataCorp (2008). Stata Statistical Software: Release 10.0. Stata Corporation: College Station, TX.Google Scholar
Stockwell, T, Sitharthan, T, McGrath, D, Lang, E (1994). The measurement of alcohol dependence and impaired control in community samples. Addiction 89, 167174.CrossRefGoogle ScholarPubMed
Tolin, DF, Foa, EB (2006). Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychological Bulletin 132, 959992.CrossRefGoogle ScholarPubMed
Tolonen, H, Helakorpi, S, Talala, K, Helasoja, V, Martelin, T, Prattala, R (2006). 25-year trends and socio-demographic differences in response rates: Finnish Adult Health Behaviour Survey. European Journal of Epidemiology 21, 409415.CrossRefGoogle ScholarPubMed
Weich, S, Hussey, D, Pickup, D, Purdon, S, McManus, S (2009 b). Psychiatric comorbidity. In Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey (ed. McManus, S., Meltzer, H., Brugha, T., Bebbington, P. and Jenkins, R.). National Centre for Social Research, London.Google Scholar
Weich, S, Patterson, J, Shaw, R, Stewart-Brown, S (2009 a). Family relationships in childhood and common psychiatric disorders in later life: systematic review of prospective studies. British Journal of Psychiatry 194, 392398.CrossRefGoogle ScholarPubMed