Peer-reviewed article
The impact of childhood sexual abuse and adverse childhood experiences on adult health related quality of life
Nancy R. Downing, Marvellous A. Akinlotan, Carly W. Thornhill ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines how childhood sexual abuse (CSA) affects adults' health and quality of life, using survey data from over 10,000 Texans. Adults who experienced CSA as children reported worse general health, more days of physical and mental illness, and more activity limitations compared to those without this history. The severity of the abuse mattered: those forced to have sex experienced worse outcomes than those who were touched or forced to touch someone else.
Key points
- 10.3% of survey respondents reported a history of childhood sexual abuse
- Adults with CSA history were 51% more likely to report poor general health
- Those with CSA history reported 86% higher odds of 14+ days of mental health problems monthly
- Adults with CSA history reported 2.2 times higher odds of 14+ days with activity limitations
- More severe forms of abuse (being forced to have sex) showed worse long-term health outcomes than less severe forms
Limitations
This study relies on self-reported retrospective data from a single state survey, which may underestimate prevalence due to underreporting of sensitive information and survivor bias. The cross-sectional design cannot establish causation or identify mediating factors that explain the relationship between CSA and poor adult health outcomes.
Abstract
BACKGROUND: Adverse childhood experiences (ACEs) have been shown to be associated with adult physical, psychological, and socioeconomic well-being, indicative of poor health-related quality of life (HRQoL). However, the association between child sexual abuse (CSA) and adult HRQoL, independent of other ACEs, has been less well examined. OBJECTIVES: To examine associations between self-reported CSA, including the nature of CSA, and adult HRQoL. PARTICIPANTS: Data are from 10,624 respondents to CSA and HRQoL questions on the 2015 Texas Behavioral Risk Factor Surveillance System survey. METHODS: Analyses included chi square and t-tests to compare sociodemographic and HRQoL differences among those with and without history of CSA. Multivariable logistic regressions were used to evaluate associations between nature of CSA and HRQoL, controlling for covariates. RESULTS: The prevalence of self-reported CSA in the sample was 10.3%. Compared to the non-exposed group, individuals exposed to CSA were more likely to report their general health as poor (AOR, 1.51; 95% CI, 1.09-2.09), report 14 or more physical unhealthy days (AOR, 1.46; 95% CI, 1.06-2.02), 14 or more mental unhealthy days (AOR, 1.86; 95% CI, 1.30-2.64), and 14 or more activity limitation days (AOR, 2.22; 95% CI, 1.58-3.10) in a month. HRQoL outcomes were worse for respondents who reported being forced to have sex as a child compared with those who reported being touched or forced to touch someone. CONCLUSIONS: Self-reported CSA is associated with lower HRQoL. The association varies by the nature of reported sexual abuse. Understanding the long-term impacts of CSA can inform adult treatment options and policies to prevent and treat CSA.