The literature consistently demonstrates evidence that child sexual abuse survivors are at greater risk of victimization later in life than the general population. This phenomenon is called sexual revictimization. Although this finding is robust, there is a large amount of variability in the prevalence rates of revictimization demonstrated in the literature. The purpose of the present meta-analysis was to calculate an average prevalence rate of revictimization across the literature and to examine moderators that may potentially account for the observed variability. Based on a review of PsycINFO and PILOTS, 1,412 articles were identified and reviewed for inclusion. This process resulted in the inclusion of 80 studies, which contained 12,252 survivors of child sexual abuse. The mean prevalence of sexual revictimization across studies was 47.9% (95% confidence intervals [43.6%, 52.3%]), suggesting that almost half of child sexual abuse survivors are sexually victimized in the future. The present study failed to find support for any of the examined moderators. Potential explanations of and implications for the results are offered, including suggestions for therapists.

Sexual victimization is an area of growing concern and increasing attention not only in the field of psychological science but also in other populations and settings including the military, college campuses, and the political arena. A plethora of difficulties and negative outcomes have been linked to childhood sexual victimization (e.g., post-traumatic stress disorder, anxiety, depression, and sleep difficulties), and one of the most consistently demonstrated is sexual revictimization (for reviews, see Beitchman, Zucker, Hood, DaCosta, & Akman, 1991, 1992; Kendall-Tackett, Williams, & Finkelhor, 1993; Maniglio, 2009; Paolucci, Genuis, & Violato, 2001; Spataro, Mullen, Burgess, Wells, & Moss, 2004). Specifically, survivors of child sexual abuse have been found to be at significantly greater risk of future sexual victimization than individuals without a history of abuse (Arata, 2002; Classen, Gronskaya Palesh, & Aggarwal, 2005; Messman-Moore & Long, 1996, 2003). This line of research is particularly important because not only is revictimization associated with many of the same adjustment difficulties as single incident victimization (e.g., post-traumatic stress disorder, dissociation, self-blame), but victims’ levels of risk for these difficulties are in fact heightened (Arata, 2002). Roodman and Clum (2001) conducted a meta-analysis of 19 studies and demonstrated an overall moderate effect size, which suggested “a definite relationship between childhood victimization and adult victimization experiences” (p. 183). However, this same meta-analysis found that the prevalence rates of sexual revictimization in the literature ranged from 15% to 79%. Roodman and Clum (2001) only included studies with female participants and reported an effect size rather than an event rate. In addition, a substantial amount of literature has been produced in the 15 years since that meta-analysis was published. Although this prior meta-analysis offers a glimpse at the issue of sexual revictimization, a more comprehensive and current quantitative review that yields an event rate of revictimization including both men and women is needed to truly understand the scale of the problem.

There is strong consensus in the field that there is a correlation between child sexual abuse and adult sexual victimization, but the exact percentage of survivors who are revictimized is unknown. The existing literature (e.g., Arata, 2002; Classen et al., 2005; Messman-Moore & Long, 1996, 2003; Roodman & Clum, 2001) has suggested that the large amount of heterogeneity observed among the documented rates of revictimization likely stems from “methodologically based variance” (Roodman & Clum, 2001, p. 184). One of the purposes of the meta-analysis conducted by Roodman and Clum (2001) was to systematically investigate potential sources of the variability; however, the results should be interpreted with caution due to the small number of studies (i.e., 19) included in the analysis. In fact, in several situations, the moderator analysis compared groups that contained only one study. Thus, a more robust examination of moderator variables in this area of the literature is warranted.

Several potential moderator variables stand out as the most likely candidates as explanations for the observed variability because they are the most consistently offered explanations and have the most preliminary empirical evidence supporting them. Although the literature has almost exclusively focused on women, Desai, Arias, Thompson, and Basile (2002) found that, in a sample of nationally representative participants, the adjusted odds ratio of predicting adult sexual victimization from child sexual abuse was greater for men (4.9) when compared to women (3.0). In one of the more comprehensive reviews of the literature, Classen, Gronskaya Palesh, and Aggarwal (2005) concluded that sexual victimization during adolescence was a more robust risk factor for revictimization when compared to childhood sexual abuse. Roodman and Clum (2001) found a rather considerable effect of sample type, with college samples yielding smaller effect sizes (.49) than other types of samples (.70). Finally, Mayall and Gold (1995) found that using strict definitions (e.g., only including contact sexual victimization, such as touching) resulted in a stronger revictimization effect, whereas broad definitions (e.g., also including noncontact victimization such as exhibitionism) can result in a failure to find evidence of a revictimization effect. Therefore, we hypothesized that including male participants, an age cutoff that includes adolescence, noncollege samples, and stricter definitions of sexual victimization would be associated with higher prevalence rates.

Due to the considerable, yet inconsistent, empirical evidence supporting the heightened risk for sexual revictimization among child sexual abuse survivors, the goal of the present meta-analysis was to inform the field about the scope of this phenomenon as a step toward increasing awareness of this issue with the hopes of informing prevention strategies and treatment planning. The present meta-analysis is the first known published meta-analysis to calculate a mean event rate of revictimization and examine sources of method variance in both male and female participants.

Discussion Sexual revictimization is a disturbingly common experience for child sexual abuse survivors, with estimates suggesting that prior sexual victimization can double or even triple an individual’s risk for future victimization (Classen et al., 2005). Although this phenomenon is well documented, the present meta-analysis highlights the inconsistencies in the literature by finding that the prevalence rates across the 80 identified studies varied greatly, ranging from 10.0% to 90.3%. These discrepancies across studies highlight the need for this study. The findings of the current meta-analysis found that, on average, almost half (i.e., 47.9%) of the 12,252 sexual victimization survivors were sexually victimized at a later time. These results confirm the considerable magnitude of this risk and further support the importance of increased awareness about this issue across many populations (e.g., colleges, military) and contexts (e.g., prevention strategies, treatment planning). The existing literature base has suggested numerous variables as potential explanations for the variability observed among the prevalence rates, including participant gender, measurement age cutoff, recruitment source, and sexual victimization definitions. However, without a comprehensive meta-analysis to quantitatively test the roles of these potential moderators, it has been unclear what impact these variables have on the prevalence rate of revictimization. Interestingly, this meta-analysis failed to find support for any of these frequently discussed factors as explanations for the huge discrepancies seen across studies. Gender The prevalence of sexual revictimization was not found to significantly differ based on participant gender; however, this finding could largely be explained by the uneven class sizes due to the majority of existing studies using strictly female participants. When the results are examined, it can be seen that there was a 9% difference in the average event rates, with studies that included men reporting higher prevalence rates, on average, than those that included only female participants. This was consistent with our hypothesis and the minimal existing literature on male revictimization (e.g., Desai, Arias, Thompson, & Basile, 2002). Because so few studies have examined sexual revictimization among men, it is unclear exactly what is driving this finding. One potential interpretation is that the majority of studies that included men recruited their participants from high-risk populations, such as lesbian, gay, bisexual, and transgender organizations (e.g., Balsam, Lehavot, & Beadnell, 2011), human immunodeficiency virus (HIV) clinics (e.g., Pantalone, Horvath, Hart, Valentine, & Kaysen, 2014), and child abuse agencies (e.g., Brenner, 1995). Therefore, it is unclear whether this increased risk of revictimization is due to participant gender, recruitment source, or both. Another potential interpretation is that men may truly be at increased risk of revictimization when compared to their female counterparts. This is consistent with literature suggesting that sexual victimization is especially distressing and associated with particularly troubling outcomes for male survivors, in part because the experience may violate gender stereotypes (e.g., men as strong and domineering) and challenges the male survivor’s self-concept and sexual identity (e.g., sexual orientation; Elliott, Mok, & Briere, 2004). It would be premature to make any conclusions based on the results presented here, particularly because of the uneven class sizes. It is imperative that future research focuses on the issue of revictimization among men because it is clear that this phenomenon is not unique to women. This article should serve as a call for such empirical work. Age Cutoff There are great discrepancies in the literature in terms of the cutoff ages used to define victimization that occurs during childhood, adolescence, and adulthood (Pereda, Guilera, Forns, & Gomez-Benito, 2009), and it has been suggested that this significantly impacts the prevalence rate of revictimization. Numerous researchers (e.g., Classen et al., 2005; Gidycz, Coble, Latham, & Layman, 1993; Gidycz, Hanson, & Layman, 1995) have suggested that sexual victimization during adolescence places survivors at greater risk of revictimization than childhood sexual abuse, thus resulting in a larger prevalence rate. However, the current meta-analysis failed to find support for any relationship between age cutoff and prevalence rate. This is consistent with the results of Roodman and Clum (2001), who also found that the age cutoff was not significantly related to the prevalence rate of revictimization. Roodman and Clum (2001) suggested that the impact of age cutoff may be more complex than simply examining the ages used in the measurement of sexual victimization at Time 1 and Time 2. For example, they found that the younger age cutoffs tended to be used with younger samples. Therefore, the mean age of the sample may be a confounding variable. Additionally, many studies placed age restrictions on the perpetrator as well (e.g., must be at least 5 years older than the victim). Therefore, it is premature to conclude that age cutoff is irrelevant when it comes to understanding variability in prevalence rates, but it suggests that the role of age may be more complex than originally suggested. Recruitment Source A large percentage (53%) of the studies relied on college samples. Roodman and Clum (2001) found that noncollege samples yielded significantly larger effect sizes than college samples. However, the present larger and more comprehensive meta-analysis failed to find that recruitment source was related to prevalence rates. Because the current meta-analysis includes more studies, as well as both male and female participants, this result brings into question the previously demonstrated finding regarding the effect of recruitment source. It should be noted that it is difficult to tease apart the influence of age, gender, and recruitment source, as college samples tended to be more female and younger than noncollege samples. One interpretation of the result is that approximately half of child sexual abuse survivors, regardless of the recruitment setting, experience sexual victimization at a later point in time. This is important because it provides support for high external validity in regard to the finding demonstrated here, and means this phenomenon is a noteworthy issue for a wide range of institutions and organizations, including colleges and the military. However, it should be kept in mind that the implications of the results discussed here are limited to the comparison of college versus noncollege samples, and did not examine more nuanced differences in recruitment source (e.g., lesbian, gay, bisexual, transgender, and queer organizations, HIV clinics). Victimization Definitions Prior research has found that the victimization definitions (i.e., strict vs. broad) used in revictimization research significantly impacts the prevalence rate. Specifically, stricter definitions have been found to be associated with a stronger relationship between child and adult victimization (Mayall & Gold, 1995; Roodman & Clum, 2001). Again, the findings presented here do not support this variable as a statistically significant moderator. The most common approach was to use strict definitions of sexual victimization at both Time 1 and Time 2, with over half (i.e., 53%) of the studies doing so. These studies found a slightly lower prevalence rate (i.e., less than 5% difference) than those studies that used one strict definition and one broad definition, or two broad definitions, but the difference was not statistically significant. It should be noted though, that the uneven class sizes may have impacted our ability to detect a difference based on victimization definition. Although the revictimization literature has suggested that the definition of victimization may impact the rate of revictimization, studies conducted on related topics within the field of sexual victimization would suggest otherwise. For example, a meta-analysis conducted by Pereda, Guilera, Forns, and Gomez-Benito (2009) found that the definition of child sexual abuse was not significantly associated with the prevalence rate of child sexual abuse within the literature. They suggested that this could, at least in part, be explained by the fact that broad definitions of victimization include incidents that would also satisfy the strict definitions. This explanation could also help explain the finding demonstrated here. It is possible that the prevalence rates did not significantly differ based on the victimization definition types because the types overlap substantially. Limitations The findings presented here should be interpreted within the context of several limitations. First, the majority of the studies identified and included in the present meta-analysis relied on retrospective data collection, and therefore could be impacted by recall bias or errors as this approach requires participants to remember events that happened, in some situations, years ago. Second, most of the studies used self-report questionnaires to determine victimization status at Time 1 and Time 2. Self-report assessment is problematic because this methodology depends on participants recognizing and endorsing that they have been sexually victimized. A recent meta-analysis found that 60.4% of female rape survivors failed to recognize that the incident they experienced was in fact rape (i.e., unacknowledged rape; Wilson & Miller, 2016). Third, due to huge variability in the age cutoffs used to measure revictimization, we created our own age cutoffs as an inclusion criteria and moderator variable. Although these represent standard cutoffs used in the literature, it resulted in many studies being excluded, such as studies that examined revictimization following sexual assault during adulthood. Therefore, the prevalence rate of revictimization demonstrated here may not generalize beyond the specific age ranges examined in the current meta-analysis. Lastly, the present meta-analysis did not take into account whether the sexual victimization was ongoing in nature and perpetrated by the same perpetrator. This was not possible because most studies in this area of the literature fail to include questions to differentiate these types of trauma. It is possible that the mean prevalence rate demonstrated here is artificially inflated because it may include studies that unknowingly detected ongoing sexual victimization rather than revictimization.

Conclusions Despite the identified limitations, the findings of the present meta-analysis have important and far-reaching implications. This meta-analysis examined a large number of studies including both men and women, college and noncollege recruitment, various age cutoffs, and a range of sexual victimization definitions. The results indicate that the present meta-analysis was not likely impacted by publication bias; therefore, there is strong evidence that the mean prevalence rate from this meta-analysis is a good representation of the event rate of revictimization in the population as a whole. With approximately half of child sexual abuse survivors experiencing later victimization, sexual revictimization is a serious and pervasive problem. The present meta-analysis failed to find evidence that the prevalence rates were significantly related to any of the examined methodological moderator variables. This is surprising given the general consensus in the literature that these factors impact the rate of revictimization detected in any given study. Because we included both male and female victims in this large-scale, comprehensive meta-analysis, the evidence presented here should be interpreted with some confidence. Rather than the prevalence rates within the literature systematically varying based on the examined participant characteristics (e.g., gender) or measurement differences (e.g., age cutoff), perhaps other factors account for the large amount of variability, such as methodological quality (e.g., retrospective vs. prospective data collection, self-report vs. clinician interview). As previously mentioned, unacknowledged rape may have also played a role in the results of the current meta-analysis. Wilson and Miller (2016) suggested that rates of victimization are higher when participants are asked behaviorally descriptive questions rather than questions that contain words such as rape. Therefore, the type of victimization questions used across the studies could help explain the variability among the prevalence rates. Although the results presented here are based on a thorough review of the literature and appear to be a good representation of revictimization among child sexual abuse survivors, additional research to further corroborate these results is strongly encouraged. Follow-up research should particularly focus on replicating these results with male survivors recruited from noncollege populations, as a large number of the input studies used female college samples. In terms of clinical implications, therapists who work with child sexual abuse survivors should be aware of the high risk of future victimization. Specifically, the findings may inform secondary prevention efforts (i.e., prevention targeted at those who have been victimized to reduce revictimization). It is strongly encouraged that treatment planning be tailored to incorporate strategies to enhance future safety. Trauma-focused cognitive-behavioral therapy (Cohen, Mannarino, & Deblinger, 2006) is an evidence-based treatment model for trauma-exposed children and adolescents that, if deemed suitable based on the client’s specific needs, may be appropriate for addressing the risk of revictimization through the development of safety skills. Safety skills are individualized based on the patient’s needs and typically involve the development and practice of a safety plan to help the child feel and be safer. This could include components of healthy sexuality and appropriate boundaries. Treatment planning, regardless of the age of the survivor, should assess for and address potential risk factors for revictimization. Additionally, an area of ongoing research is the mechanisms behind revictimization. Although there is no consensus within the existing literature, some evidence suggests that factors such as emotion regulation, risky behaviors, risk perception, and substance use are associated with the risk of revictimization (Gidycz, Loh, Lobo, Rich, & Lynn, 2007; Gidycz, McNamara, & Edwards, 2006; Messman-Moore, Walsh, & DeLillo, 2010). Future meta-analytic research should examine potential individual differences on these variables that may help us better understand risk for revictimization. The goal of the present meta-analysis was to calculate an average event rate of sexual revictimization across the literature, and include both male and female survivors. Through this process, we have highlighted that although a few prior studies have examined revictimization in male survivors, the focus, up to this point, has been on female survivors. This is particularly important given that the preliminary evidence presented here suggests that men may be at greater risk of revictimization, although follow-up research is needed. Regardless, this study provides strong support for the importance of sexual victimization research, particularly in terms of efforts surrounding prevention strategies and treatment planning. Sexual victimization, and subsequently revictimization, is a serious public health problem that merits increased attention.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.