TORONTO -- Most research on child sexual-abuse survivors focuses on negative consequences such as depression and suicide. A new study instead examines factors associated with resilience and flourishing among adult survivors.

"Remarkably, two-thirds [65%] of the childhood sexual-abuse survivors in our sample met the criteria for complete mental health -- defined as being happy or satisfied with life most days in the past month, having high levels of social and psychological well-being in the past month, and being free of mental illness, suicidal thoughts and substance dependence in the past year," reported lead author Dr. Esme Fuller-Thomson, Professor at the University of Toronto's Factor-Inwentash Faculty of Social Work (FIFSW) and Director of the Institute for Life Course & Aging. "While the prevalence of complete mental health among childhood sexual-abuse survivors is higher than we had expected, it is still substantially less than that found in the general population [77%]. Greater understanding of factors associated with complete mental health among survivors is an important first step in helping survivors achieve the level of well-being found in the general adult population."

The negative association between childhood sexual abuse and complete mental health was completely explained when we took into account the individuals' history of mental illness, substance abuse, chronic pain and social isolation. In other words, we now have an understanding of the pathways that decrease resiliency among child sexual-abuse survivors.

"If the survivors had been depressed at any point in their life, the odds of them currently being in complete mental health declined dramatically. This underlines the importance of mental-health interventions for this population. A promising intervention, cognitive behavioral therapy [CBT], has been tested and found effective at reducing post-traumatic stress disorder and depressive and anxiety symptoms among childhood sexual-abuse survivors," said co-author Dr. Ashley Lacombe-Duncan, a recent doctoral graduate from the FIFSW and Assistant Professor of Social Work at the University of Michigan.

"Having a confidante was found to be the second-strongest single predictor of complete mental health, increasing the odds of past-year complete mental health nearly sevenfold. Given the importance of family and social-support systems, brief interventions to address trauma post-experience and bolster social and familial support are also called for," suggested Dr. Deborah Goodman, Director, Child Welfare Institute, Children's Aid Society of Toronto.

Sexual-abuse survivors who had chronic pain had half the odds of complete mental health compared to those who were free of chronic pain. "It is important that health and social-service professionals help sexual-abuse survivors get the treatment they need to address both their physical health problems, such as chronic pain conditions, in addition to their mental-health concerns," said Dr. Barbara Fallon, Professor at the FIFSW and Canada Research Chair in Child Welfare.

The study, published online ahead of print in Social Psychiatry and Psychiatric Epidemiology, was based on a 2012 Canadian nationally representative survey of 17,014 adults of whom 651 were childhood sexual-abuse survivors. Those who were physically abused during their childhood or who had been exposed to chronic parental domestic violence were excluded from the analysis. "By expanding our research focus from the devastating consequences of childhood sexual abuse to factors correlated with well-being in adulthood, we may be able to help design more effective interventions for those affected to not only survive, but thrive," said Fuller-Thomson.

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