Systematic review of meta-analytic studies assessing the prevalence of child sexual abuse and A meta-analysis of the prevalence of contact and non-contact child sexual abuse as reported by adolescents in the past 10 years
Power, Christina Louise
Objectives: The thesis comprises two parts. Firstly, a systematic review (SR) systematically examined meta-analytic studies assessing the prevalence of sexual abuse in childhood. A meta-analysis sought to systematically identify and synthesise data from studies providing prevalence estimates of contact and non-contact child sexual abuse (CSA) as self-reported by adolescents within the past 10 years. Methods: Consistent with Cochrane Collaboration guidelines, the systemic review adopted a comprehensive search of electronic databases and additional sources, including communication with authors working in the field, and the use of ancestry and descendency approaches between February 2013 and March 2014. The meta-analysis also adopted an equally systematic search conducted from March 2013 to June 2014. Assessment of quality and risk of bias were conducted on the included studies using PRISMA criteria and STROBE guidelines. Results: The systematic review identified six meta-analytic studies for review. The quality of studies and the range of definitional and methodological factors studied varied; results sections were well covered, whereas, quality and risk of bias within studies were generally poorly addressed. Prevalence estimates varied considerably and high heterogeneity was consistent across all analyses. Nine population studies measuring prevalence of contact and non-contact CSA were included in the meta-analysis. Meta-analyses were conducted overall and across male and female populations. Prevalence estimates varied considerably across studies, with contact CSA ranging from 2% to 39.8% and overall non-contact CSA, estimates ranged from 1% to 24.6%. Substantial heterogeneity was present across all analyses and therefore findings should be interpreted with caution. Nevertheless, the findings were thought-provoking and most likely due to differences in definitions of CSA and inconsistent use of validated instruments. Conclusions: Child sexual abuse is an international problem which is highly pervasive across all societies and populations studied. Females consistently report higher rates of CSA than males, and some Asian countries, namely China, produce relatively lower CSA estimates, even controlling for a wide range of methodological factors and study characteristics. The considerable heterogeneity was apparent both between and within studies and it appears likely based on the current findings, and in the context of previous research, that there are a wide range of methodological and socio-demographic factors which moderate CSA prevalence estimates. More specifically, the lack of a universally recognised definition of CSA proves especially problematic for researchers. The issue is further complicated by use of non-standardised instruments and inconsistent reporting and dissemination of findings. There is a need for future epidemiological studies to adhere to universal guidelines using standard definitions, standardisation of instruments and standardisation of reporting and dissemination to facilitate development of health policies, resource allocation and prevention initiatives for clinical and social services.