Article summary of Resilience in Survivors of Child Sexual Abuse: A Systematic Review of the Literature by Domhardt et al. - Chapter

Preface

The short and long-term effects of sexual abuse involve a wide range of mental disorders, such as: PTSS, depression, anxiety, aggression and substance abuse. However, not everyone suffers from a psychiatric disorder after they experienced sexual abuse. Some people maintain a normal level of functioning. These people are seen as being 'resilient', which is defined as being able to positively adjust during and after a (major) setback. To date, there has been no consensus on the operationalization of the concept of 'resilience'. The majority of the studies included in this study define resilience as adaptive functioning or as the absence of psychopathological symptoms. 

Protective factors

Protective factors are related to resilience and refer to the buffers of an individual. Research into sexual abuse in general has found empirical evidence for both individual and environmental protective factors. Individual protective factors include personal characteristics such as: openness, extraversion, agreeableness, having an internal locus of control, optimism, etc. Environmental protective factors associated with resilience are: receiving social support from family, colleagues, teachers or other significant others.

Goals

This systematic study of the literature has four goals:

• Providing an overview of the protective factors associated with the resilience specific to a particular form of sexual abuse

• Determining outcomes and protective factors of different developmental stages

• Estimating and emphasizing the level of resilience of child abuse survivors 

• Evaluating the quality of the included studies on the basis of a quality assessment and view methodological issues in the discussion

Method

Criteria

The following criteria have been applied in this study:

• Studies must be published in English, German or French that comply with peer review policy

• Studies looked at resilience after the occurrence of sexual abuse

• Resilience is defined in as adaptive functioning or the absence of psychological symptoms

• The most important outcomes were assessed on the basis of standardized tests

• Only quantitative studies were included

• The sample consists of at least twenty participants

• Studies were included if they measured both short-term resilience during childhood and adolescence as well as long-term resilience in adulthood

• Studies using different characteristics were included

Strategy identification of relevant articles

Two methods have been used to record relevant studies. First, the database was searched with certain combinations of search terms. Second, a snowball technique was applied, in which the reference lists of all relevant studies were reviewed to note further studies. 

Categorization of protective factors

According to various researchers, protective factors can be divided into three broad categories.

• Internal factors of the victim

• External factors of the victim's family

• External factors related to the broader social environment of the victim

Furthermore, a distinction has been made between three different age groups. Participants under the age of ten were categorized as children. Adolescents were defined as participants from 11 to 17 years of age and starting from 18 years of age the participants were categorized as adults.

Results

The study looked at protective factors that are related to resilience after being sexually abused. The following results are a summary of the studies included in this review.

Internal factors

Optimism and hope

A study found that in adolescents, both hope and expectations, predicted resilience. In adults, optimism and hope appeared to play a protective role in HIV-infected adults who were sexually abused. 

Control beliefs and internal locus of control

In a longitudinal study of sexually abused adolescents, a greater sense of empowerment was associated with resilience. In adults, having an internal locus of control was characterized as a protective factor for mental health and self-esteem. Having an external locus of control, on the other hand, was characterized as a risk factor for drug addiction.

Externalize debt, trauma-related beliefs and cognition

To blame others instead of blaming yourself, or externalizing guilt, was associated with resilience.

Active coping

In children, avoidance behavior was on the one hand associated with fewer behavioral problems, but on the other hand it was associated with more sexual anxiety in some studies. For adolescents, the use of an avoidance strategy proved to be a risk factor for negative results.

Education

Those who had more certainty about their plans for education achieved a stronger academic performance and had more positive feelings about education compared to those with lower certainty. Academic performance proved to be a protective factor for self-esteem in adults. It was also found that obtaining a diploma in high school was significantly correlated with resilience.

Emotional intelligence, interpersonal competence and trust

Understanding and dealing with emotions, which is defined as emotional intelligence, proved to be a protective factor for adolescents against suicidal thoughts and suicide attempts. Furthermore, interpersonal and emotional competence was associated with lower levels of recall of sexual events. In adults, interpersonal competence was predictive of resilience.

Social attachment

Higher emotional attachment in one's own family proved to be protective among female students, but not among male students. Secure attachment in parent-child relationships proved to be protective against the negative effects of sexual abuse. 

Self confidence

A sense of self-esteem predicted subjective health among female victims and appeared to be protective against interpersonal problems, being sexual and taking sexual risk behavior.

Individual employment and socio-economic status (SES)

A personal high SES proved to be protective against psychopathology. Furthermore, current job was positively associated with self-esteem, but not with psychopathology.

Family factors

Family social support

For children, the support from the father, support from both parents and the emotional support from counselors served as a protective factor. In adolescents, parental care, family connectedness, parenting support, caregiver support, and emotional support from counselors served as a protective factor. For adults, family support, social support satisfaction, mother care, nature and quality of family relationships, paternal support childhood and partner support were found to be protective factors.

Environmental factors

Various forms of social support at the community level have been associated with resilience. Satisfaction with the social support of the community turned out to be a protective factor for women who were sexually abused in their childhood. The nature and quality of the relationship with peers in adolescence was also associated with a resilient outcome at the age of 18.

Club involvement

Participation in club activities was associated with less recall of sexual events. However, this only applied to those who experienced a lower level of abuse, not to those who experienced a high level of abuse.

Discussion

Research into resilience in the aftermath of sexual abuse can be valuable because it can provide valuable information about protective factors. In turn, this information can be used to design interventions and prevention programs to help those people who have experienced sexual abuse. Strong evidence was found for individual factors such as education, interpersonal and emotional competence, control beliefs, active coping, optimism, social attachment and the appointment of external culprits. In addition, there is considerable empirical evidence for both the importance of social support for the family and social support at the environmental level.  

Critical findings and implications

• Knowledge about resilience can guide the development of treatment and prevention programs

• The best supporting protective factors are education, interpersonal and emotional competence, control beliefs, social support of the family and the broader social environment

• Level of resilience among participants who were sexually abused turned out to be between ten and 53 percent

• Preventive and clinical interventions must make use of psychoeducation and cognitive strategies. This must be adjusted to the level of development of victims

• Future research should focus on the mechanisms that underlie an effective and healthy adaptation after sexual abuse. A longitudinal study would be best, since resilience is a dynamic process with different levels in different contexts