The epidemiology of child sexual abuse: An analysis of definitions used in prevalence studies and recommendations to advance the field

Despite the worldwide magnitude of child sexual abuse (CSA) and increasing awareness of its impact on victims, the sexual abuse of children has yet to be fully acknowledged as a policy issue that requires extensive societal... [ view full abstract ]

Despite the worldwide magnitude of child sexual abuse (CSA) and increasing awareness of its impact on victims, the sexual abuse of children has yet to be fully acknowledged as a policy issue that requires extensive societal prevention and intervention. We hypothesize that the field of CSA does not receive full recognition, due in part to a lack of agreement on what should legally and socially be considered under the umbrella term of CSA. As part of a program of research exploring this issue, our objective in this study was to explore the different definitions of CSA adopted in prevalence studies conducted internationally. We conducted a systematic review of prevalence studies of CSA published between 2000 and 2015. Two independent raters coded study variables, focusing on how the dimensions of ‘child’, ‘sexual’ and ‘abuse’ were articulated in each of the definitions used to measure CSA. The review yielded 187 studies. Findings confirmed the wide - and concerning - diversity of definitions used throughout studies. The concept of ‘child’ was either implied (‘were you a victim during your childhood’) or defined as an event that occurred before a specific age that ranged from age 12 to 18. The ‘sexual’ nature of the acts differed tremendously across definitions, from specific terms (‘were you exposed to genitals’), to broad accounts (‘were you sexually abused’). The ‘abusive’ nature of the experiences also varied widely across definitions, including factors such as relationship with perpetrator, age difference between victim and perpetrator, grooming behaviors, and victims’ lack of consent. The field of CSA is clearly awaiting a well-agreed upon definition that recognizes the complexity of CSA experiences, yet offers a common language to inform practice, policy and epidemiology research. Specific recommendations on what should constitute the dimensions of ‘child’, ‘sexual’ and ‘abuse’ in CSA definitions will be proposed.