Swanston Heather Y, Parkinson Patrick N, Oates R Kim, O'Toole Brian I, Plunkett Angela M, Shrimpton Sandra
Department of Psychological Medicine, The Children's Hospital at Westmead (The Royal Alexandra Hospital for Children), NSW, Australia.
Child Abuse Negl. 2002 Feb;26(2):115-27. doi: 10.1016/s0145-2134(01)00311-8.
To determine the incidence of re-abuse in children known to have been sexually abused and to find factors that increase the risk of re-abuse.
The study group consisted of 183 children with substantiated sexual abuse who presented to two children's hospitals' Child Protection Units in Sydney, Australia during 1988 through 1990. At intake, when the children were aged between 5 years and 15 years, data about the child, the family, and the nature of the index sexual abuse were collected. Six years after presentation for the abuse, records of the Department of Community Services were checked to see if any of the young people had been the subject of substantiated notifications for abuse/neglect before and after intake to the study. Predictors of notifications for abuse/neglect after presentation for the index sexual abuse were identified.
Of the sexually abused young people, nearly one in three were the subject of subsequent substantiated notifications to the Department of Community Services for some form of child abuse and neglect or behavior which placed them at risk of harm. Later notifications for abuse/neglect were predicted by notifications for emotional abuse before the index sexual abuse (adjusted RR = 4.88, CI: 1.43 to 16.65), severity of the index sexual abuse (p = .03), and the number of changes in the child's primary caregivers before intake (p = .03). Approximately one in six of the sexually abused young people were notified for sexual abuse after intake to the study. One in 10 also had prior notifications for sexual abuse. Sexual abuse notifications after study intake were predicted by caregiver changes before intake (p = .01) and whether or not there were notifications for emotional abuse before the index sexual abuse (adjusted RR = 3.40, CI: 1.05 to 11.02).
Revictimization of children appears to be a marker of ongoing family dysfunction. Intervention in child sexual abuse needs to consider a range of risk factors associated with re-abuse and, in particular, should focus on family functioning if further abuse is to be prevented.
确定已知遭受性虐待儿童再次受虐的发生率，并找出增加再次受虐风险的因素。
研究组由183名经证实遭受性虐待的儿童组成，这些儿童于1988年至1990年期间前往澳大利亚悉尼的两家儿童医院的儿童保护部门就诊。在入院时，当儿童年龄在5岁至15岁之间时，收集了有关儿童、家庭以及首次性虐待性质的数据。在因虐待就诊六年后，检查社区服务部的记录，以查看这些年轻人中是否有任何人在进入该研究之前和之后曾因虐待/忽视而被证实受到通报。确定了首次性虐待就诊后虐待/忽视通报的预测因素。
在遭受性虐待的年轻人中，近三分之一随后因某种形式的虐待儿童、忽视或使其处于受伤害风险的行为而被社区服务部证实通报。首次性虐待之前的情感虐待通报（调整后相对危险度=4.88，可信区间：1.43至16.65）、首次性虐待的严重程度（p=0.03）以及入院前儿童主要照顾者的更换次数（p=0.03）可预测后来的虐待/忽视通报。在进入该研究后，约六分之一遭受性虐待的年轻人因性虐待而被通报。十分之一的人之前也有过性虐待通报。研究入院后的性虐待通报可通过入院前照顾者的更换情况（p=0.01）以及首次性虐待之前是否有情感虐待通报来预测（调整后相对危险度=3.40，可信区间：1.05至11.02）。
儿童再次受害似乎是家庭功能持续失调的一个标志。对儿童性虐待的干预需要考虑一系列与再次受虐相关的风险因素，特别是如果要防止进一步的虐待，应关注家庭功能。
