Swinburne University of Technology, Australia.
Swinburne University of Technology, Australia.
Child Abuse Negl. 2019 Apr;90:174-184. doi: 10.1016/j.chiabu.2019.01.015. Epub 2019 Feb 22.
There are well established links between child sex abuse (CSA) and a range of mental health adversities in the literature. However, there has been very limited examination of mental health care needs of CSA survivors, indicated by contacts with mental health professionals. Similarly, no existing research has examined rates of prescription of psychopharmacology to CSA survivors. Service utilisation is a vital component of the health landscape, and a clear understanding of the mental health care needs of CSA survivors is central to policy formation regarding mental health funding. Therefore, this study aimed to assess differences in rates of mental health care utilisation and rates of prescription of psychopharmacology during adulthood between individuals with a history of CSA and a comparison sample from the general population without a known abuse history.
PARTICIPANTS, SETTING, AND METHOD: The forensic medical records of 2433 CSA victims identified between 1964 and 1995 were linked to Australian medical and medication-use data accessed between 2010 and 2015, when victims were, on average, aged between 28.78 and 33.78 years. CSA cases were compared to a matched comparison cohort on rates of contact with mental health professionals and prescriptions for mood stabilisers, anxiolytics, antipsychotics, stimulants, analgesics and addiction treatment medication.
CSA was associated with increased levels of attendance at psychiatrists (OR = 1.29, p < .001), psychologists and clinical social workers (OR = 6.68, p < .001) and general practitioners (OR = 1.76, p < .001) for mental health care. CSA was also associated with increased frequency of prescription of all categories of psychopharmacology (ORs ranging from 1.40 to 6.18). Outcomes differed by victim gender and age at abuse. Abused females demonstrated greater overall service and medication utilisation than abused males. Females abused after puberty (age 12 years) had more frequent contacts with general practitioners for mental health care and greater frequency of prescription of psychopharmacology than females abused under age 12 years, including elevated frequency of analgesic and mood stabiliser use. Males abused after puberty also demonstrated higher frequency of service utilisation, including inflated rates of antipsychotic and anxiolytic prescriptions and visits to psychiatrists.
Experiencing CSA was associated with increased use of psychopharmacology and contact with health professionals for mental health care. Abused females and participants abused after age 12 demonstrated most inflated use of services. These findings have important implications for policy decisions regarding the provision of mental health care to CSA survivors deemed to be at risk of developing mental health difficulties.
文献中有充分的证据表明儿童性虐待（CSA）与一系列心理健康不良后果之间存在关联。然而，对于 CSA 幸存者的心理健康护理需求，仅有非常有限的接触心理健康专业人员的研究。同样，没有现有的研究检查 CSA 幸存者的精神药理学处方率。服务利用是卫生领域的一个重要组成部分，清楚地了解 CSA 幸存者的心理健康护理需求是制定心理健康资金政策的核心。因此，本研究旨在评估有 CSA 病史的个体与一般人群中无已知虐待史的对照样本之间，在成年期心理健康护理利用率和精神药理学处方率方面的差异。
参与者、设置和方法：1964 年至 1995 年间确定的 2433 名 CSA 受害者的法医记录与 2010 年至 2015 年期间获取的澳大利亚医疗和药物使用数据相关联，此时受害者的平均年龄在 28.78 至 33.78 岁之间。将 CSA 病例与匹配的对照组进行比较，比较两组接触心理健康专业人员和开处情绪稳定剂、抗焦虑药、抗精神病药、兴奋剂、镇痛药和成瘾治疗药物的情况。
CSA 与看精神科医生（OR=1.29，p<.001）、心理学家和临床社会工作者（OR=6.68，p<.001）和全科医生（OR=1.76，p<.001）的次数增加有关，以获得心理健康护理。CSA 还与所有类别的精神药理学处方的频率增加有关（OR 范围为 1.40 至 6.18）。结果因受害者的性别和受虐年龄而异。受虐待的女性比受虐待的男性表现出更高的总体服务和药物利用。青春期后（12 岁）受虐待的女性与全科医生接触治疗心理健康的次数更多，精神药理学处方的频率也更高，包括镇痛药和情绪稳定剂的使用频率增加。青春期后受虐待的男性也表现出更高的服务利用率，包括抗精神病药和抗焦虑药处方和看精神科医生的频率增加。
经历 CSA 与精神药理学的使用增加和寻求心理健康护理的健康专业人员接触有关。受虐待的女性和 12 岁后受虐待的参与者表现出最膨胀的服务利用。这些发现对关于为被认为有发展心理健康问题风险的 CSA 幸存者提供心理健康护理的政策决策具有重要意义。
