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Association Between Self-reported Childhood Sexual Abuse and Adverse Psychosocial Outcomes
Results From a Twin Study
Elliot C. Nelson, MD;
Andrew C. Heath, DPhil;
Pamela A. F. Madden, PhD;
M. Lynne Cooper, PhD;
Stephen H. Dinwiddie, MD;
Kathleen K. Bucholz, PhD;
Anne Glowinski, MD;
Tara McLaughlin, PhD;
Michael P. Dunne, PhD;
Dixie J. Statham, MCP;
Nicholas G. Martin, PhD
Arch Gen Psychiatry. 2002;59:139-145.
Background Increased risk for serious adverse outcomes has been associated with
a history of childhood sexual abuse (CSA). Whether these risks are directly
attributable to CSA rather than family background remains controversial.
Methods Structured psychiatric telephone interviews were conducted from February
1996 to September 2000 with both members of 1991 same-sex pairs (1159 female
and 832 male pairs) from a young adult Australian volunteer twin panel (mean
[SD] age, 29.9 [2.5] years). A binary composite CSA variable was constructed
from responses to 5 component questions. The association between CSA and adverse
psychosocial outcomes was examined, controlling for family background.
Results A history of CSA, reported by 16.7% of the women and 5.4% of the men,
was more common among those reporting parental alcohol-related problems. Significantly
increased risk was observed in women reporting a history of CSA for subsequently
occurring major depression, suicide attempt, conduct disorder, alcohol dependence,
nicotine dependence, social anxiety, rape after the age of 18 years, and divorce;
most similar risks reached statistical significance in men. The greatest risks
were associated with CSA involving intercourse. Childhood sexual abuse–negative
twins (ie, those who denied having experienced CSA) from CSA-discordant pairs
compared with other CSA-negative individuals had increased risk for many adverse
outcomes suggesting correlated family background risk factors. Childhood sexual
abuse–positive members (ie, those who reported having experienced CSA)
of CSA-discordant pairs had significantly greater risk for all 8 examined
adverse outcomes than their co-twins.
Conclusions Self-reported CSA was associated with increased risk for adverse outcomes,
controlling for family background. Family background risk factors also were
associated with adverse outcome risk. Discordant pair analysis seems to provide
an effective means of controlling for family background risk factors.
From the Department of Psychiatry, Washington University School of
Medicine, St Louis, Mo (Drs Nelson, Heath, Madden, Bucholz, Glowinski, and
McLaughlin); Department of Psychology, University of Missouri–Columbia
(Dr Cooper); Finch University of the Health Sciences–The Chicago Medical
School, North Chicago, Ill (Dr Dinwiddie); Queensland University of Technology,
Kelvin Grove, Australia (Dr Dunne); and Queensland Institute of Medical Research,
Brisbane, Australia (Ms Statham and Dr Martin).
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