ROLE OF CHILDHOOD SEXUAL ABUSE ON THE OCCURRENCE OF MENTAL ILLNESS IN ADULTHOOD IN PATIENTS SEEN IN THE UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL: A CASE CONTROL STUDY

Abstract

Childhood sexual abuse (CSA) is a public health crisis with growing evidence of its profound impact on the well-being of survivors. It is a major public health problem that has been largely under-reported and under-studied in sub-Saharan Africa. Specifically in Nigeria, there is generally a dearth of research in the area of the mental health sequelae of CSA. This study was thus aimed at examining the relationship between CSA and mental illness in adults. It compared the prevalence and characteristics of CSA in patients with mental illness (cases) and patients who screened negative for mental illness (controls). The study also sought to identify the types of mental illnesses occurring in those exposed and not exposed to CSA among the cases. Furthermore, the influence of family relationship on the association between CSA and mental illness in adulthood was also examined.
The study was conducted in the University of Port Harcourt Teaching Hospital (UPTH) as a case control study involving 152 cases, selected by systematic sampling from the mental health out-patient clinic and 152 age and sex matched controls, selected from the general out-patient clinic. Data was collected using a self-administered questionnaire in the same manner for both cases and controls. Data analysis was done using Epi Info version 7.
The prevalence of CSA was higher among the cases (29.6%) than the controls (13.2%). There was a significant association between CSA and mental illness (p<0.001), with the odds of exposure to CSA being 2.8 times higher among the cases than the controls. The most frequent
ROLE OF CHILDHOOD SEXUAL ABUSE ON THE OCCURRENCE OF MENTAL ILLNESS IN ADULTHOOD IN PATIENTS SEEN IN THE UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL: A CASE CONTROL STUDY
Okeafor, I. N. 13
age category for onset of CSA exposure was 13-17 years for the cases and 6-12 years for the controls. In both cases and controls, females were more commonly abused and males were the most common perpetrators. Although not statistically significant, the study noted that cases were more exposed to penetrative form of CSA, had higher frequency of abuse of above five times and higher prevalence of intra-familial (incestuous) and stranger-perpetrated abuse than the controls. Mental and Behavioural Disorders (MBD) due to psychoactive substance use had the highest relative frequency among the cases with CSA exposure in comparison to the cases without CSA exposure. The influence of family relationship on the association between CSA and mental illness was investigated by stratification. The stratified analysis showed that both the crude odds ratio (2.78) and the adjusted odds ratio (2.70) all fell within the confidence intervals of the stratum–specific odds ratio of functional family (1.91, 95% CI: 0.48 – 7.58) and dysfunctional family (2.96, 95% CI: 1.52 -5.78). Thus excluding family relationship as a confounder. Additionally, logistic analysis showed that after controlling for family relationship, the association between CSA and mental illness was still significant (p<0.01).
There is a significant association between experiencing CSA and the later development of mental illness in adulthood irrespective of family relationship. This study therefore recommends an increase in public health enlightenment on the mental health sequelae of CSA in adult life, stronger advocacy for the enforcement of the Child’s Right Act as well as the protection of children from being exposed to sexual abuse

ROLE OF CHILDHOOD SEXUAL ABUSE ON THE OCCURRENCE OF MENTAL ILLNESS IN ADULTHOOD IN PATIENTS SEEN IN THE UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL: A CASE CONTROL STUDY