Full Text

Turn on search term navigation

1. Introduction

Childhood maltreatment (CM) including neglect and emotional, sexual, and physical abuse has been recognized as a global public-health and social-welfare problem [1,2,3,4]. In high-income countries, about 4–16% of children suffered from physical abuse annually, and about 10% of children were neglected or emotionally abused [3]. It was reported that approximately 702,000 children were determined to be victims of childhood maltreatment nationally each year in the United States [5]. Among children aged 14–17 years in the USA, the estimated lifetime rate was 38.1% for childhood maltreatment, 18.1% for physical abuse, 23.9% for emotional abuse, 18.4% for neglect [2]. The estimated prevalence of childhood maltreatment among college students was 64.7% in China [6]. Research on the short- and long-term consequences of childhood maltreatment suggests that it substantially contributes to child mortality and morbidity, both internalizing and externalizing psychiatric disorders, criminal behaviors, substance use and risky sexual behavior in adolescence and adulthood [5,7,8,9,10].

Likewise, risky sexual behaviors (RSBs) in adolescence and adulthood represent a serious public health concern that may lead to poor reproductive health outcomes such as sexually transmitted diseases (STDs), human immunodeficiency virus (HIV), unintended pregnancy and pelvic inflammatory diseases [11,12]. Childhood maltreatment is associated with higher risk of RSBs including early sexual debut, higher number of partners, unprotected sexual intercourse, engagement in transactional sex and teen pregnancy [9,13,14,15]. Attachment theory, developmental traumatology and neurobiological dysregulation are common theoretical approaches to explain the mechanism linking CM and RSBs [16]. A robust body of literature connecting childhood maltreatment and risky sexual behavior has focused on outcomes for sexual abuse in particular [17,18,19,20]. The relationship between childhood sexual abuse (CSA) and subsequent RSBs in adolescence and adulthood has also been well established in both high-risk and general population [21,22,23,24,25]. However, there is equivocal evidence that other maltreatment forms predict risky sexual behavior as strongly as CSA [26,27,28]. A prospective study with a 30-year follow-up documented that physical abuse, sexual abuse, and neglect increased risk of early sexual contact and prostitution [29]. Furthermore, according to another prospective birth cohort study, the association between sexual abuse, physical abuse, emotional abuse, and neglect and early age at sexual intercourse was independent after adjusting for confounding factors [9]. Additionally, in that study, neglect was found to be also associated with multiple sexual partners and emotional abuse with higher rates of miscarriage.

Following these results, when exploring the effects of childhood maltreatment on risky sexual behaviors, different subtypes need to be considered. Previous systematic reviews and meta-analysis [30,31,32,33] focused only on the relationship between sexual abuse and risky sexual behaviors, thus the association between childhood maltreatment and RSBs has yet to be systematically and quantitatively reviewed. A meta-analysis of nine articles indicated that sexually abused boys compared with non-abused boys were at a higher risk of having unprotected intercourse (OR = 1.91), having multiple sexual partners (OR = 2.91) and causing a pregnancy (OR = 4.81) [31]. Another meta-analysis demonstrated that childhood sexual abuse was associated with a 1.59 times greater likelihood of RSBs, and the significant association did not vary by gender. Based on previous research, we hypothesized that childhood maltreatment, as well as specific forms of childhood maltreatment, all increased the risk of having RSBs in adolescence and adulthood [30]. The aims of the current meta-analysis were twofold. First, we aimed to provide a systematic meta-analysis exploring the effect of childhood maltreatment and its subtypes on subsequent RSBs in adolescence and adulthood. Second, we identified potential heterogeneity moderators by subgroup and sensitivity analysis.

2. Materials and Methods 2.1. Literature Search

We conducted the present meta-analysis strictly following the proposed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) statement. A systematic search of relevant articles in PubMed, Google Scholar, EMBASE, Medline was undertaken by two researchers. The following search terms were applied: “adolescent risky sexual behaviors”, “adult risky sexual behaviors”, “adolescent reproductive health outcomes”, “adult reproductive health outcomes”, “childhood maltreatment”, “child abuse”, “child adversity”, “child trauma”, “child neglect”, “child physical abuse”, “child emotional abuse”. We limited our searches to studies that were published between 1990 and 2018 and written in English, this time frame was chosen because the awareness of childhood maltreatment and its potential consequences was heightened globally during the time. We also manually searched review articles and reference lists of relevant studies.

2.2. Exposure and Outcome Indicators of Interest

The exposure of interest was childhood maltreatment, which was further categorized into childhood sexual abuse (CSA), childhood physical abuse (CPA), childhood emotional abuse (CEA) and childhood neglect (CN). The outcomes of interest were risky sexual behaviors, including at least one of the following outcomes: early sexual debut, multiple sexual partners, transactional sex or unprotected sex. In our study, we focused not only on the association between total childhood maltreatment and any form of RSBs, but the association between subtypes of childhood maltreatment and any form of RSBs.

2.3. Inclusion Criteria

We identified studies satisfying the following criteria: (1) population-based observational quantitative studies; (2) studies reported subtype(s) of childhood maltreatment such as childhood sexual, physical or emotional abuse, and/or neglect; (3) studies reported the associations between a history of childhood maltreatment and any form of risky sexual behavior; (4) studies included participants of both genders and reported the outcomes of the total sample; and (5) studies reported the relative risks (RRs) and odd ratios (ORs), with corresponding 95% confidence intervals (CIs) (or data to calculate them).

2.4. Data Extraction and Quality Assessment

Two independent researchers (WZY, HM) extracted data and assessed study quality. The two researchers agreed upon any discrepancies through discussion and if necessary referred the issue to a third researcher. Using a study-designed standardized form, we extracted the available information as follows: first author, year of publication, study design, study country, total sample, subtype of childhood maltreatment and quality score. We used a ten-point Newcastle–Ottawa Scale (NOS) to assess the quality of included studies in the present review. Each study was judged on three broad perspectives: the selection of the study groups; the comparability of the groups; and the ascertainment of either the exposure or outcome of interest. When the study wins seven or more stars, it is considered of higher methodologic quality.

2.5. Statistical Analysis

We abstracted one effect size per outcome from each primary study. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used given the majority of the studies were cross-sectional. When evidence of heterogeneity existed across studies, we used random-effects models to calculate the pooled OR and the corresponding 95% CI, whereas fixed-effects models were used. When multiple types of childhood maltreatment were reported in the same study, the effect values of the relationship between different types of childhood maltreatment and the risk of having any form of risky sexual behaviors were combined with statistical software. Homogeneity of effect size across studies was tested by using the Q statistics at the P < 0.10 level of significance. The I2 statistic, which is a quantitative measure of inconsistency across studies, was also calculated (significance level at I2 > 50%).

A series of sub-group analyses according to geographic region, assessment method of CM, study design, study sample, study quality and year of publication were conducted to assess the potential effect modification of these variables on outcomes. We also conducted a sensitivity analysis by removing individual studies one at a time and recalculated a pooled OR to examine whether any one study overtly influenced the pooled effect size. We examined the possibility of publication bias, using Egger’s test and Begg’s rank correlation test (significance level at P < 0.10). All statistical analyses were performed using Stata version 13.0 and Review Manager version 5.3.

3. Results 3.1. Search Results and Study Characteristics

We initially identified 4100 potentially eligible records from the electronic databases. Two additional articles were found from reference lists. Finally, 19 eligible studies were identified (Figure 1). The characteristics of included literatures, which involved 74,557 participants and were published between 1990 and 2018, were summarized in Table 1. Among the 19 studies included, 11 (57.9%) studies were conducted in America, 3 (15.8%) in Asia, 1 (5.3%) in Oceania, 1 (5.3%) in Europe and 3 (15.8%) in Africa. The majority, 73.7% (n = 14), of included studies were cross-sectional whereas 26.3% (n = 5) were cohort studies. 8 (42.1%) studies were considered of higher methodological quality, achieving a quality score ≥ 7 out of 9. The outcomes of early sexual debut in 6 studies were reported, multiple sexual partners in 15 studies, transactional sex in 8 studies, and unprotected sex in 9 studies. The number of studies reporting the exposure of subtypes of CM were as follows: 5 CSA, 4 CPA, 2 CEA, and 3 CN in early sexual debut; 12 CSA, 8 CPA, 4 CEA, and 5 CN in multiple sexual partners; 8 CSA, 2 CPA, and 1 CN in transactional sex; 9 CSA and 2 CPA in unprotected sex.

3.2. Childhood Maltreatment and Risk of Having an Early Sexual Debut

Overall, childhood maltreatment was associated with a 2.22 times greater likelihood of having an early sexual debut (OR = 2.22; 95% CI: 1.64–3.00). However, significant heterogeneity was found (I2 = 81%, P < 0.01) (Figure 2). With regard to specific CM subtypes, the present meta-analysis showed the risk of having an early sexual debut was significantly increased in adolescents and adults who experienced CSA (OR = 3.59; 95%CI: 1.95–6.62), CPA (OR = 1.54; 95%CI: 0.94–2.51), CEA (OR = 1.72; 95%CI: 1.24–2.39), and CN (OR = 1.58 95%CI: 1.03–2.43). Nevertheless, there was substantial heterogeneity except for CEA (I2 = 9%; P = 0.29) (Figure 3).

3.3. Childhood Maltreatment and Risk of Having Multiple Sexual Partners

The results of pooled estimates for the association between childhood maltreatment and having multiple sexual partners was 2.22 (95% CI: 1.78–2.76). Yet, substantial heterogeneity was found (I2 = 91%, P < 0.01) (Figure 2). With regard to specific CM subtypes, the present meta-analysis showed those who experienced CSA (OR = 2.63; 95% CI: 1.95–3.54), CPA (OR = 1.54; 95% CI: 1.28–1.86), CEA (OR = 1.74; 95% CI: 1.22–2.49) or CN (OR = 1.44; 95% CI: 1.08–1.92) had a significant higher risk of having multiple sexual partners. However, substantial heterogeneity was found in all groups, with I2 as 84%, 58%, 73%, 79%, and the P value was <0.01, 0.02, 0.01 and <0.01, respectively (Figure 4).

3.4. Childhood Maltreatment and Risk of Having Transactional Sex

The overall pooled OR for the association between childhood maltreatment and having transactional sex was 3.05 (95% CI: 1.92–4.86). However, substantial heterogeneity was found (I2 = 84%; P < 0.01) (Figure 2). With regard to specific CM subtypes, the present meta-analysis showed CSA (OR = 3.24; 95% CI: 2.10–4.99) or CPA (OR = 1.86; 95% CI: 1.20–2.89) was associated with higher risk of having transactional sex. Evidence of heterogeneity was observed for CSA (I2 = 74%; P < 0.01), but not for CPA (I2 = 20%; P = 0.26) (Figure 5).

3.5. Childhood Maltreatment and Risk of Having Unprotected Sex

The pooled OR for the association between childhood maltreatment and having unprotected sex was 1.59 (95% CI: 1.22–2.09). Nevertheless, substantial heterogeneity was found (I2 = 88%; P < 0.01) (Figure 2). With regard to specific CM subtypes, the present meta-analysis showed individuals experiencing CSA (OR = 1.57; 95% CI: 1.16–2.13) or CPA (OR = 1.25; 95% CI: 1.08–1.44) had a higher risk of having unprotected sex. Significant heterogeneity was found in CSA (I2 = 88%; P < 0.01), but not in CPA (I2 = 38%; P = 0.20) (Figure 6).

3.6. Subgroup Analysis

Subgroup analyses for risk estimates between childhood maltreatment and risky sexual behaviors are summarized in Table 2. Overall, a significantly increased risk of having RSBs was found in most of subgroups. For risk estimates between childhood maltreatment and having an early sexual debut, after subgroup analysis, study design (test for subgroup difference (TSD): I2 = 54.4%) was identified as the relevant heterogeneity moderator. However, the risk of having an early sexual debut was not statistically different for study design (P= 0.14). For risk estimates between childhood maltreatment and having multiple sexual partners, after subgroup analysis, study design (TSD: I2 = 90.6%), assessment method of CM (TSD: I2 = 67.1%) and geographic region (TSD: I2 = 2.8%) were identified as the first three most relevant heterogeneity moderators. The risk of having multiple sexual partners was statistically different for study design (P < 0.01). For risk estimates between childhood maltreatment and having transactional sex, after subgroup analysis, geographic region (TSD: I2 = 85.5%), study design (TSD: I2 = 1.1%) and quality score (TSD: I2 = 1.1%) were identified as the first three most relevant heterogeneity moderators. The risk of having transactional sex was statistically different for geographic region (P < 0.01). For risk estimates between childhood maltreatment and having unprotected sex, after subgroup analysis, study design (TSD: I2 = 87.3%), study sample (TSD: I2 = 71.7%) and geographic region (TSD: I2 = 59.2%) were identified as the first three most relevant heterogeneity moderators. The risk of having unprotected sex was statistically different for study design (P < 0.01).

3.7. Sensitivity Analysis

Sensitivity analyses were conducted to assess the stability of the results. We removed individual studies one at a time and recalculated a pooled OR to examine whether any one study overtly influenced the pooled effect size. Sensitivity analyses showed exclusion of any single study at a time did not materially alter the overall pooled estimates. For risk estimates between childhood maltreatment and having an early sexual debut, the pooled OR ranged from 1.91 (1.54–2.37) to 2.28 (1.55–3.34); for risk estimates between childhood maltreatment and having multiple sexual partners, the pooled OR ranged from 2.02 (1.66–2.46) to 2.33 (1.89–2.88); for risk estimates between childhood maltreatment and having transactional sex, the pooled OR ranged from 2.46 (1.80–3.34) to 3.46 (2.21–5.43); for risk estimates between childhood maltreatment and having unprotected sex, the pooled OR ranged from 1.44 (95% CI: 1.13–1.85) to 1.70 (95% CI: 1.27–2.29).

3.8. Publication Bias

Both the Begg’s rank correlation test (P = 0.024) and Egger’s test (P = 0.020) indicated evidence of publication bias for risk estimates between CM and having an early sexual debut. Evidence of publication bias was observed by Egger’s test (P = 0.008), but not observed by Begg’s rank correlation test (P = 0.075) for risk estimates between CM and having multiple sexual partners. No indication of publication bias was observed by Begg’s rank correlation test (P = 0.174 for transactional sex; P = 0.522 for unprotected sex) or Egger’s test (P = 0.741 for transactional sex; P = 0.329 for unprotected sex) for risk estimates between CM and having transactional sex and having unprotected sex.

4. Discussion

Our meta-analysis yielded the following main findings. First, overall, childhood maltreatment was significantly associated with an increased risk of having an early sexual debut (OR = 2.22), multiple sexual partners (OR = 2.22), transactional sex (OR = 3.05) and unprotected sex (OR = 1.59). Second, different types of childhood maltreatment were also significantly associated with an increased risk of RSBs. For example, CSA (OR = 3.59), CEA (OR = 1.72) or CN(OR = 1.58) was significantly associated with risk of having an early sexual debut; CSA (OR = 2.63), CPA (OR = 1.54), CEA (OR = 1.74) and CN (OR = 1.44) also increased the risk of having multiple sexual partners; individuals experiencing CSA and CPA had a significantly higher risk of having transactional sex (ORCSA = 3.24, ORCPA = 1.86) and having unprotected sex (ORCSA = 1.57, ORCPA = 1.25). Third, the association between childhood maltreatment and higher risk of RSBs still existed after subgroup and sensitivity analyses, indicating our results were stable and credible.

So far, there are four existing reviews [30,31,32,33] that evaluated the association of childhood maltreatment with RSBs. However, these reviews exclusively focused on CSA and little is known about the effect of other types of childhood maltreatment on RSBs. Our study has important strengths compared with previous meta-analyses. To our knowledge, our study was the first meta-analysis to examine the relationship between childhood maltreatment (which was further categorized into CSA, CPA, CEA and CN) and RSBs. Additionally, sufficient numbers of studies reported the same individual outcome to be able to meta-analyze RSB outcomes separately. In our study, more than half of studies had a large sample size (>1000); 45.0% studies were considered of higher methodological quality and these high-quality studies contributed most study participants. With the accumulating evidence and enlarged sample size, we have enhanced statistical power to provide more precise and reliable risk estimates. To handle the heterogeneity, sub-group analyses according to geographic region, assessment method of CM, study design, study sample, study quality and year of publication were conducted in our study. The most relevant heterogeneity moderators were identified by subgroup analysis. We found that the association between childhood maltreatment and risk of RSBs remains statistically significant after subgroup and sensitivity analyses.

The exact mechanisms involved in the association between childhood maltreatment and RSBs are still unclear, but attachment theory could provide further insight into them [16]. Evidences show childhood maltreatment may lead to an insecure attachment that then plays a role in risky sexual behaviors [16,45,46]. From a theoretical perspective, maltreated victims are more likely to engage unwanted SRBs to avoid disapproval and rejection or have casual sexual behaviors to inhibit the development of deep emotional attachment. Consistent with this theory, individuals with adverse childhood neglect may increase the likelihood of having multiple sexual partners, to evade contact and closeness with others [47]. However, maltreated individuals may also use sex as means for securing affection and intimacy, potentially leading to earlier sexual debut [29,30].

In addition, trauma symptoms appear to be an important explanation for the link [48]. Childhood maltreatment may cause a range of internalizing problems in childhood and cause trauma symptoms by distorting the child’s concept of self and others, world view, or affective capacities, making victims vulnerable to RSBs during adolescence or adulthood [9,49,50]. Evidence shows shame, feelings of betrayal or powerlessness components of trauma symptoms in individuals experiencing CEA and CSA may reduce awareness of protective behaviors, in particular contraceptive use [51,52,53]. Furthermore, individuals with maltreated histories may use alcohol to cope with these trauma symptoms, and previous studies have proposed that alcohol use may lead to high risk of RSBs [47,54]. Alexithymia was also confirmed as a mediator of the relationship between CM and subsequent risky sexual behaviors. Individuals who have experienced childhood maltreatment have emotional deficiencies in understanding and expressing emotions and may suffer from social isolation and poor interpersonal relationships [55]. Thus, they may be likely to seek immediate interpersonal interactions through risky sexual behavior.

Of course, there are other potential explanations for the association between CM and risk of RSBs. Recent studies on the neurobiological perspective show that CM is associated with reduced medial prefrontal cortex (mPFC) gray matter and the alterations may possibly enhance sexual decision making and risky sexual behaviors [56,57]. Moreover, maltreated children may have higher rates of sexual preoccupation, that may result in more sexual stimulation, particularly an early sexual debut [58,59]. Finally, ADHD symptoms in maltreated individuals were reported to be associated with early sexual debut and multiple partners [5,60].

The present meta-analysis has some limitations. First, the substantial heterogeneity among studies for the association between childhood maltreatment and RSBs were observed. However, this heterogeneity is not surprising given the differences in sociodemographic status and methodology. In our study, we conducted subgroup analyses to explain some extent of this heterogeneity and have identified the main heterogeneity moderators, including study design, assessment method of CM, geographic region, study sample and quality score. Although heterogeneity was still observed after subgroup or sensitivity analyses, the association between childhood maltreatment and RSBs still existed and the results were stable. However, many primary studies in our meta-analysis did not provide information on other variables which could explain some of the variance, such as duration of maltreatment, severity of maltreatment, the age of onset, perpetrator and comorbid disorders.

Second, the majority of studies enrolled in the analyses were cross-sectional studies and retrospective cohort studies with the possibility of recall bias in self-reported childhood maltreatment and RSBs, thereby under- or over-estimating the strength of the association. However, evidence indicated the recall of childhood maltreatment remained fairly accurate over a long time. Third, discrepancies also existed in the definition of both CM (subtypes including CSA, CPA, CEA and CN) and RSBs, and the measurement of the constructs, frequency, and time frames of the outcomes, therefore our findings should be interpreted with caution. Fourth, many primary studies focused on school and community samples and few studies included street-involved youth and homeless individuals, thus our study may not be generalizable to other adolescent and adult populations. Finally, our study only included studies published in English, additional research in other populations is warranted to generalize the findings.

Our study has important implications both for future research and prevention. To reduce the consequences of CM, we should be aware that not only child sexual abuse leads to RSBs, all forms of CM and other specific forms of CM (CPA, CEA and CN) also contribute to RSBs. It is crucial to carry out research to clarify the unique effects of different forms of CM on RSBs and provide the evidence to take intervention measures in the future. However, out of 19 studies, only one of the included studies is from Europe, which indicates more sound research is supposed to be conducted in this valuable field. With regard to prevention, our findings highlight the need for effective programs and policies to screen for childhood maltreatment and provide more medical and reproductive health services for people who have experienced child maltreatment.

5. Conclusions

In conclusion, the findings of our meta-analysis indicate that childhood maltreatment and its subtypes increase the risk of RSBs, although the potential bias and evidence of heterogeneity should be carefully considered. The current meta-analysis indicates that it is necessary to screen for maltreated history in childhood and provide health education and support for maltreated individuals, which have crucial implications for clinical practice and interventions.

Figure 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) statement flow diagram.

Figure 2. Forest plot for childhood maltreatment and risk of risky sexual behaviors (RSBs).

Figure 3. Forest plot for subtypes of childhood maltreatment and risk of having an early sexual debut.

Figure 4. Forest plot for subtypes of childhood maltreatment and risk of having multiple sexual partners.

Figure 5. Forest plot for subtypes of childhood maltreatment and risk of having transactional sex.

Figure 6. Forest plot for subtypes of childhood maltreatment and risk of having unprotected sex.

Study Author(s) (Year) Geographic Region Sample Size Assessment of CM Study Design Study Sample Quality Sore Form(s) of CM
Abajobir (2018) [9] Oceania3081Substantiated recordCohort studyOther8CSA, CPA, CEA, CN
Ahrens (2012) [34] America574SRCohort studyOther6CSA
Chartier (2009) [20] America8116SRCross-sectional studyOther6CSA, CPA
Chiang (2015) [35] Africa3739SRCross-sectional studyOther6CSA
Ding (2018) [36] Asia4974SRCross-sectional studyOther6CSA
Jordanova Peshevska (2014) [37] America1277SRCross-sectional studySchool sample7CPA, CN
Thibodeau (2017) [38] America1940SRCross-sectional studySchool sample7CSA, CPA

CN
Ramiro (2010) [13] Asia1068SRCross-sectional studyOther6CSA, CPA

CEA, CN
Nelson (1995) [27] America1957SRCross-sectional studySchool sample5CPA
VanderEnde (2018) [15] Africa610SRCross-sectional studyOther6CSA, CPA

CEA
London (2017) [39] America12288SRCohort studyOther7CSA, CPA

CEA, CN
Diehl (2018) [23]America134SRCross-sectional studyOther5CSA
Agardh (2011) [40]Africa980SRCross-sectional studySchool sample5CSA
Tang (2018) [24] Asia17966SRCross-sectional studySchool sample7CSA
Van Dorn (2005) [41] America609SRCross-sectional studyOther5CSA
Voisin (2005) [42] America409SRCross-sectional studySchool sample6CSA
Howard (2005) [43] America13601SRCross-sectional studySchool sample7CSA
Wilson (2008) [29] America1070Substantiated recordCohort studyOther9CSA, CPA
Zierler (1991) [44] Europe164SRCohort studyOther7CSA

SR: self-reported; CM: childhood maltreatment; CSA: childhood sexual abuse; CPA: childhood physical abuse; CEA: childhood emotional abuse; CN: childhood neglect.

Subgroup Early Sexual Debut Multiple Sexual Partners Transactional Sex Unprotected Sex
Geographic RegionTSD: I2 = 0% P = 0.38TSD: I2 = 2.8% P = 0.38TSD: I2 = 85.5% P < 0.01TSD: I2 = 59.2% P = 0.06
America1.65 (1.04, 2.63) n = 22.00 (1.49, 2.69) n = 72.29 (1.55, 3.38) n = 41.71 (1.14, 2.55) n = 4
I2 = 82% P = 0.02I2 = 93% P < 0.01I2 = 64% P = 0.04I2 = 91% P < 0.01
Asia3.27 (1.26, 8.60) n = 23.12 (1.94, 5.03) n = 37.40 (5.09, 10.77) n = 11.98 (0.87, 4.50) n = 2
I2 = 91% P < 0.01I2 = 88% P < 0.01Not applicableI2 = 92% P < 0.01
EuropeNot applicable 2.00 (1.41, 2.83) n = 14.00 (2.00, 8.00) n = 11.00 (0.80, 1.26) n = 1
Not applicableNot applicableNot applicable
Other2.18 (1.73, 2.75) n = 21.83 (1.49, 2.24) n = 42.40 (1.29, 4.49) n = 21.43 (1.00, 2.04) n = 2
I2 = 0% P = 0.74I2 = 42% P = 0.16I2 = 0% P = 0.41I2 = 33% P = 0.22
Assessment of CMTSD: I2 = 0% P = 0.72TSD: I2 = 67.1% P = 0.08TSD: I2 = 0% P = 0.56Not applicable
Substantiated records2.12 (1.72, 2.61) n = 21.66 (1.27, 2.17) n = 12.56 (1.68, 3.90) n = 2
I2 = 0% P = 0.98Not applicableI2 = 0% P = 0.60Not applicable
Self-report2.33 (1.41, 3.85) n = 42.28 (1.80, 2.88) n = 143.18 (1.75, 5.79) n = 61.59 (1.22, 2.09) n = 9
I2 = 88% P < 0.01I2 = 92% P < 0.01I2 = 88% P < 0.01I2 = 88% P < 0.01
Study designTSD: I2 = 54.4% P = 0.14TSD: I2 = 90.6% P < 0.01TSD: I2 = 1.1% P = 0.31TSD: I2 = 87.3% P < 0.01
Cross-sectional study2.86 (1.69, 4.86) n = 32.62 (2.03, 3.38) n = 113.74 (1.79, 7.83) n = 41.70 (1.27, 2.29) n = 8
I2 = 82% P < 0.01I2 = 89% P < 0.01I2 = 86% P < 0.01I2 = 88% P < 0.01
Cohort study1.79 (1.29, 2.48) n = 31.46 (1.15, 1.86) n = 42.39 (1.51, 3.78) n = 41.00 (0.80, 1.26) n = 1
I2 = 75% P = 0.02I2 = 76% P < 0.01I2 = 63% P = 0.05Not applicable
Study sampleTSD: I2 = 0% P = 0.67TSD: I2 = 0% P = 0.53Not applicableTSD: I2 = 71.7% P = 0.06
School sample2.49 (1.14, 5.42) n = 32.42 (1.72, 3.38) n = 7 1.91 (1.26, 2.89) n = 5
I2 = 92% P < 0.01I2 = 92% P < 0.01Not applicableI2 = 93% P < 0.01
Other2.10 (1.77, 2.48) n = 32.08 (1.51, 2.87) n = 83.05 (1.92, 4.86) n = 81.16 (0.98, 1.37) n = 4
I2 = 0% P = 0.99I2 = 91% P < 0.01I2 = 84% P < 0.01I2 = 37% P = 0.19
Quality scoreTSD: I2 = 0% P = 0.80TSD: I2 = 0% P = 0.67TSD: I2 = 1.1% P = 0.31TSD: I2 = 0% P = 0.85
≥72.02 (1.43, 2.87) n = 42.11 (1.51, 2.96) n = 72.39 (1.51, 3.78) n = 41.55 (1.06, 2.25) n = 4
I2 = 88% P < 0.01I2 = 94% P < 0.01I2 = 66% P = 0.02I2 = 93% P < 0.01
<72.14 (1.70, 2.69) n = 22.31 (1.83, 2.92) n = 83.74 (1.79, 7.83) n = 41.64 (1.04, 2.59) n = 5
I2 = 0% P = 0.65I2 = 74% P < 0.01I2 = 86% P < 0.01I2 = 81% P < 0.01
Year of publicationTSD: I2 = 0% P = 0.74TSD: I2 = 0% P = 0.56TSD: I2 = 0% P = 0.59TSD: I2 = 0% P = 0.80
<20132.13 (1.77, 2.56) n = 32.38(1.76, 3.21) n = 72.58 (1.98, 3.35) n = 31.54 (1.01, 2.35) n = 5
I2 = 0% P = 0.90I2 = 85% P < 0.01I2 = 0% P = 0.40I2 = 89% P < 0.01
≥20132.40 (1.21, 4.75) n = 32.09 (1.53, 2.85) n = 83.27 (1.43, 7.47) n = 51.67 (1.05, 2.66) n = 4
I2 = 92% P < 0.01I2 = 93% P < 0.01I2 = 90% P < 0.01I2 = 91% P < 0.01

CM: childhood maltreatment; TSD: test for subgroup differences.

Author Contributions

Conceptualization, Z.-Y.W. and M.H.; methodology, Z.-Y.W.; software, Z.-Y.W. and M.H.; validation, M.H., T.-L.Y. and J.Y.; formal analysis, Z.-Y.W., M.H. and T.-L.Y.; resources, M.H.; data curation, Z.-Y.W.; writing-original draft preparation, M.H. and Z.-Y.W.; writing-review and editing, Z.-Y.W.; visualization, Z.-Y.W.; supervision, M.H.; project administration, M.H.; funding acquisition, M.H.

Funding

This research was funded by the National Natural Science Foundation of China, grant number 81402770.

Conflicts of Interest

The authors declare no conflict of interest.

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

1. Norman, R.E.; Byambaa, M.; De, R.; Butchart, A.; Scott, J.; Vos, T. The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLoS Med. 2012, 9, e1001349.

2. Finkelhor, D.; Turner, H.A.; Shattuck, A.; Hamby, S.L. Prevalence of Childhood Exposure to Violence, Crime, and Abuse: Results From the National Survey of Children's Exposure to Violence. JAMA Pediatr. 2015, 169, 746-754.

3. Gilbert, R.; Widom, C.S.; Browne, K.; Fergusson, D.; Webb, E.; Janson, S. Burden and consequences of child maltreatment in high-income countries. Lancet 2009, 373, 68-81.

4. Tran, B.X.; Pham, T.V.; Ha, G.H.; Ngo, A.T.; Nguyen, L.H.; Vu, T.T.M.; Do, H.N.; Nguyen, V.; Nguyen, A.T.L.; Tran, T.T.; et al. A Bibliometric Analysis of the Global Research Trend in Child Maltreatment. Int. J. Environ. Res. Public Health 2018, 15, 1456.

5. Jaffee, S.R. Child Maltreatment and Risk for Psychopathology in Childhood and Adulthood. Annu. Rev. Clin. Psychol. 2017, 13, 525-551.

6. Fu, H.; Feng, T.; Qin, J.; Wang, T.; Wu, X.; Cai, Y.; Lan, L.; Yang, T. Reported prevalence of childhood maltreatment among Chinese college students: A systematic review and meta-analysis. PLoS ONE 2018, 13, e0205808.

7. Nelson, J.; Klumparendt, A.; Doebler, P.; Ehring, T. Childhood maltreatment and characteristics of adult depression: Meta-analysis. Br. J. Psychiatry J. Ment. Sci. 2017, 210, 96-104.

8. Clayton, K.; Lee, J.B.; Cheung, K.; Theule, J.; Henrikson, B. Quantifying the Relationship between Attention-Deficit/Hyperactivity Disorder and Experiences of Child Maltreatment: A Meta-Analysis. Child Abus. Rev. 2018, 27, 361-377.

9. Abajobir, A.A.; Kisely, S.; Williams, G.; Strathearn, L.; Najman, J.M. Risky Sexual Behaviors and Pregnancy Outcomes in Young Adulthood Following Substantiated Childhood Maltreatment: Findings From a Prospective Birth Cohort Study. J. Sex Res. 2018, 55, 106-119.

10. Abajobir, A.A.; Kisely, S.; Scott, J.G.; Williams, G.; Clavarino, A.; Strathearn, L.; Najman, J.M. Childhood Maltreatment and Young Adulthood Hallucinations, Delusional Experiences, and Psychosis: A Longitudinal Study. Schizophr. Bull. 2017, 43, 1045-1055.

11. Yoon, S.; Voith, L.A.; Kobulsky, J.M. Gender differences in pathways from child physical and sexual abuse to adolescent risky sexual behavior among high-risk youth. J. Adolesc. 2018, 64, 89-97.

12. Fowler, P.J.; Motley, D.; Zhang, J.; Rolls-Reutz, J.; Landsverk, J. Adolescent maltreatment in the child welfare system and developmental patterns of sexual risk behaviors. Child Maltreatment 2015, 20, 50-60.

13. Ramiro, L.S.; Madrid, B.J.; Brown, D.W. Adverse childhood experiences (ACE) and health-risk behaviors among adults in a developing country setting. Child Abus. Negl. 2010, 34, 842-855.

14. Hahm, H.C.; Lee, Y.; Ozonoff, A.; Van Wert, M.J. The impact of multiple types of child maltreatment on subsequent risk behaviors among women during the transition from adolescence to young adulthood. J. Youth Adolesc. 2010, 39, 528-540.

15. VanderEnde, K.; Chiang, L.; Mercy, J.; Shawa, M.; Hamela, J.; Maksud, N.; Gupta, S.; Wadonda-Kabondo, N.; Saul, J.; Gleckel, J.; et al. Adverse Childhood Experiences and HIV Sexual Risk-Taking Behaviors Among Young Adults in Malawi. J. Interpers. Violence 2018, 33, 1710-1730.

16. Thibodeau, M.E.; Lavoie, F.; Hebert, M.; Blais, M. Pathways Linking Childhood Maltreatment and Adolescent Sexual Risk Behaviors: The Role of Attachment Security. J. Sex Res. 2017, 54, 994-1005.

17. Abdala, N.; Li, F.; Shaboltas, A.V.; Skochilov, R.V.; Krasnoselskikh, T.V. History of Childhood Abuse, Drinking Motives, Alcohol Use, and Sexual Risk Behavior Among STD Clinic Patients in St. Petersburg, Russia: A Cross-Sectional Study. AIDS Behav. 2016, 20, 512-522.

18. Jones, D.J.; Lewis, T.; Litrownik, A.; Thompson, R.; Proctor, L.J.; Isbell, P.; Dubowitz, H.; English, D.; Jones, B.; Nagin, D.; et al. Linking childhood sexual abuse and early adolescent risk behavior: The intervening role of internalizing and externalizing problems. J. Abnorm. Child Psychol. 2013, 41, 139-150.

19. Senn, T.E.; Carey, M.P. Child maltreatment and women's adult sexual risk behavior: Childhood sexual abuse as a unique risk factor. Child Maltreatment 2010, 15, 324-335.

20. Chartier, M.J.; Walker, J.R.; Naimark, B. Health Risk Behaviors and Mental Health Problems as Mediators of the Relationship between Childhood Abuse and Adult Health. Am. J. Public Health 2009, 99, 847-854.

21. Tomori, C.; McFall, A.M.; Srikrishnan, A.K.; Mehta, S.H.; Nimmagadda, N.; Anand, S.; Vasudevan, C.K.; Solomon, S.; Solomon, S.S.; Celentano, D.D. The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India. BMC Public Health 2016, 16, 784.

22. Wekerle, C.; Goldstein, A.L.; Tanaka, M.; Tonmyr, L. Childhood sexual abuse, sexual motives, and adolescent sexual risk-taking among males and females receiving child welfare services. Child Abus. Negl. 2017, 66, 101-111.

23. Diehl, A.; Clemente, J.; Pillon, S.C.; Santana, P.R.H.; da Silva, C.J.; Mari, J.J. Early childhood maltreatment experience and later sexual behavior in Brazilian adults undergoing treatment for substance dependence. Rev. Bras. Psiquiatr. 2018.

24. Tang, K.; Qu, X.; Li, C.; Tan, S. Childhood sexual abuse, risky sexual behaviors and adverse reproductive health outcomes among Chinese college students. Child Abus. Negl. 2018, 84, 123-130.

25. Williams, J.K.; Wilton, L.; Magnus, M.; Wang, L.; Wang, J.; Dyer, T.P.; Koblin, B.A.; Hucks-Ortiz, C.; Fields, S.D.; Shoptaw, S.; et al. Relation of Childhood Sexual Abuse, Intimate Partner Violence, and Depression to Risk Factors for HIV among Black Men Who Have Sex with Men in 6 US Cities. Am. J. Public Health 2015, 105, 2473-2481.

26. Thompson, M.P.; Kingree, J.B.; Lamis, D. Associations of adverse childhood experiences and suicidal behaviors in adulthood in a U.S. nationally representative sample. Child Care Health Dev. 2019, 45, 121-128.

27. Nelson, D.E.; Higginson, G.K.; Grant-Worley, J.A. Physical abuse among high school students. Prevalence and correlation with other health behaviors. Arch. Pediatr. Adolesc. Med. 1995, 149, 1254-1258.

28. Klein, H.; Elifson, K.W.; Sterk, C.E. Childhood neglect and adulthood involvement in HIV-related risk behaviors. Child Abus. Negl. 2007, 31, 39-53.

29. Wilson, H.W.; Widom, C.S. An examination of risky sexual behavior and HIV in victims of child abuse and neglect: A 30-year follow-up. Health Psychol. 2008, 27, 149-158.

30. Homma, Y.; Wang, N.; Saewyc, E.; Kishor, N. The relationship between sexual abuse and risky sexual behavior among adolescent boys: A meta-analysis. J. Adolesc. Health 2012, 51, 18-24.

31. Abajobir, A.A.; Kisely, S.; Maravilla, J.C.; Williams, G.; Najman, J.M. Gender differences in the association between childhood sexual abuse and risky sexual behaviours: A systematic review and meta-analysis. Child Abus. Negl. 2017, 63, 249-260.

32. Paolucci, E.O.; Genuis, M.L.; Violato, C. A meta-analysis of the published research on the effects of child sexual abuse. J. Psychol. 2001, 135, 17-36.

33. Arriola, K.R.; Louden, T.; Doldren, M.A.; Fortenberry, R.M. A meta-analysis of the relationship of child sexual abuse to HIV risk behavior among women. Child Abus. Negl. 2005, 29, 725-746.

34. Ahrens, K.R.; Katon, W.; McCarty, C.; Richardson, L.P.; Courtney, M.E. Association between childhood sexual abuse and transactional sex in youth aging out of foster care. Child Abus. Negl. 2012, 36, 75-80.

35. Chiang, L.F.; Chen, J.; Gladden, M.R.; Mercy, J.A.; Kwesigabo, G.; Mrisho, F.; Dahlberg, L.L.; Nyunt, M.Z.; Brookmeyer, K.A.; Vagi, K. HTV and childhood sexual violence: Implications for sexual risk behaviors and HIV testing in Tanzania. AIDS Educ. Prev. 2015, 27, 474-487.

36. Ding, R.; Wen, X.; He, P.; Guo, C.; Luo, Y.; Song, X.; Zheng, X. Association between Childhood and Adolescent Sexual Abuse Experiences and High-Risk Sexual Behaviors among Chinese Youth. Sex. Med. 2018, 6, 273-281.

37. Jordanova Peshevska, D.; Raleva, M.; Filov, I.; Sethi, D.; Jordanova, T.; Hazdi Hamza, K.; Tozija, F.; Damchevska Ilievska, V. Association between physical abuse, physical neglect and health risk behaviors among young adolescents: Results from the national study. Maced. J. Med. Sci. 2014, 7, 380-385.

38. Thibodeau, M.E.; Lavoie, F.; Hebert, M.; Blais, M. Childhood maltreatment and adolescent sexual risk behaviors: Unique, cumulative and interactive effects. Child Abus. Negl. 2017, 72, 411-420.

39. London, S.; Quinn, K.; Scheidell, J.D.; Frueh, B.C.; Khan, M.R. Adverse Experiences in Childhood and Sexually Transmitted Infection Risk from Adolescence into Adulthood. Sex. Transm. Dis. 2017, 44, 524-532.

40. Agardh, A.; Odberg-Pettersson, K.; Ostergren, P.O. Experience of sexual coercion and risky sexual behavior among Ugandan university students. BMC Public Health 2011, 11, 527.

41. Van Dorn, R.A.; Mustillo, S.; Elbogen, E.B.; Dorsey, S.; Swanson, J.W.; Swartz, M.S. The effects of early sexual abuse on adult risky sexual behaviors among persons with severe mental illness. Child Abus. Negl. 2005, 29, 1265-1279.

42. Voisin, D.R. The relationship between violence exposure and HIV sexual risk behavior: Does gender matter? Am. J. Orthopsychiatry 2005, 75, 497-506.

43. Howard, D.E.; Wang, M.Q. Psychosocial correlates of U.S. adolescents who report a history of forced sexual intercourse. J. Adolesc. Health 2005, 36, 372-379.

44. Zierler, S.; Feingold, L.; Laufer, D.; Velentgas, P.; Kantrowitz-Gordon, I.; Mayer, K. Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. Am. J. Public Health 1991, 81, 572-575.

45. Wong, J.Y.; Choi, E.P.; Chan, C.K.; Fong, D.Y. Controlling Anxiety Mediates the Influence of Childhood Adversities on Risky Sexual Behaviors among Emerging Adults. J. Sex Res. 2017, 54, 1018-1025.

46. Suzuki, H.; Tomoda, A. Roles of attachment and self-esteem: Impact of early life stress on depressive symptoms among Japanese institutionalized children. BMC Psychiatry 2015, 15, 8.

47. Walsh, K.; Latzman, N.E.; Latzman, R.D. Pathway from child sexual and physical abuse to risky sex among emerging adults: The role of trauma-related intrusions and alcohol problems. J. Adolesc. Health 2014, 54, 442-448.

48. Thompson, R.; Lewis, T.; Neilson, E.C.; English, D.J.; Litrownik, A.J.; Margolis, B.; Proctor, L.; Dubowitz, H. Child Maltreatment and Risky Sexual Behavior: Indirect Effects through Trauma Symptoms and Substance Use. Child Maltreatment 2017, 22, 69-78.

49. Trickett, P.K.; Noll, J.G.; Putnam, F.W. The impact of sexual abuse on female development: Lessons from a multigenerational, longitudinal research study. Dev. Psychopathol. 2011, 23, 453-476.

50. Castro, M.; Alcantara-Lopez, M.; Martinez, A.; Fernandez, V.; Sanchez-Meca, J.; Lopez-Soler, C. Mother's IPV, Child Maltreatment Type and the Presence of PTSD in Children and Adolescents. Int. J. Environ. Res. Public Health 2017, 14, 1077.

51. Masters, N.T.; George, W.H.; Davis, K.C.; Norris, J.; Heiman, J.R.; Jacques-Tiura, A.J.; Gilmore, A.K.; Nguyen, H.V.; Kajumulo, K.F.; Otto, J.M.; et al. Women's unprotected sex intentions: Roles of sexual victimization, intoxication, and partner perception. J. Sex Res. 2014, 51, 586-598.

52. English, D.J.; Thompson, R.; White, C.R. Predicting risk of entry into foster care from early childhood experiences: A survival analysis using LONGSCAN data. Child Abus. Negl. 2015, 45, 57-67.

53. Payne, J.S.; Galvan, F.H.; Williams, J.K.; Prusinski, M.; Zhang, M.; Wyatt, G.E.; Myers, H.F. Impact of childhood sexual abuse on the emotions and behaviours of adult men from three ethnic groups in the USA. Cult. Health Sex. 2014.

54. Chen, A.C.; Thompson, E.A.; Morrison-Beedy, D. Multi-system influences on adolescent risky sexual behavior. Res. Nurs. Health 2010, 33, 512-527.

55. Hahn, A.M.; Simons, R.M.; Simons, J.S. Childhood Maltreatment and Sexual Risk Taking: The Mediating Role of Alexithymia. Arch. Sex. Behav. 2016, 45, 53-62.

56. Chocyk, A.; Majcher-Maslanka, I.; Dudys, D.; Przyborowska, A.; Wedzony, K. Impact of early-life stress on the medial prefrontal cortex functions-A search for the pathomechanisms of anxiety and mood disorders. Pharmacol. Rep. 2013, 65, 1462-1470.

57. Gutnik, L.A.; Hakimzada, A.F.; Yoskowitz, N.A.; Patel, V.L. The role of emotion in decision-making: A cognitive neuroeconomic approach towards understanding sexual risk behavior. J. Biomed. Inform. 2006, 39, 720-736.

58. Noll, J.G.; Haralson, K.J.; Butler, E.M.; Shenk, C.E. Childhood maltreatment, psychological dysregulation, and risky sexual behaviors in female adolescents. J. Pediatr. Psychol. 2011, 36, 743-752.

59. Dodge, B.; Reece, M.; Cole, S.L.; Sandfort, T.G. Sexual compulsivity among heterosexual college students. J. Sex Res. 2004, 41, 343-350.

60. Isaksson, J.; Stickley, A.; Koposov, R.; Ruchkin, V. The danger of being inattentive-ADHD symptoms and risky sexual behaviour in Russian adolescents. Eur. Psychiatry 2018, 47, 42-48.

Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha 410078, China

*Author to whom correspondence should be addressed.

Word count: 6677

Show less

© 2019. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

[...]risky sexual behaviors (RSBs) in adolescence and adulthood represent a serious public health concern that may lead to poor reproductive health outcomes such as sexually transmitted diseases (STDs), human immunodeficiency virus (HIV), unintended pregnancy and pelvic inflammatory diseases [11,12]. [...]we identified potential heterogeneity moderators by subgroup and sensitivity analysis. 2. Inclusion Criteria We identified studies satisfying the following criteria: (1) population-based observational quantitative studies; (2) studies reported subtype(s) of childhood maltreatment such as childhood sexual, physical or emotional abuse, and/or neglect; (3) studies reported the associations between a history of childhood maltreatment and any form of risky sexual behavior; (4) studies included participants of both genders and reported the outcomes of the total sample; and (5) studies reported the relative risks (RRs) and odd ratios (ORs), with corresponding 95% confidence intervals (CIs) (or data to calculate them). [...]19 eligible studies were identified (Figure 1).

Details

Title
The Relationship between Childhood Maltreatment and Risky Sexual Behaviors: A Meta-Analysis
Author
Zi-Yu, Wang; Hu, Ming; Tao-Lin, Yu; Yang, Jun
Publication year
2019
Publication date
2019
Publisher
MDPI AG
ISSN
1661-7827
e-ISSN
1660-4601
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.3390/ijerph16193666
ProQuest document ID
2329602960
Copyright
© 2019. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.