Cinsel istismara uğramış gençlerin sosyodemografik, gelişimsel, ruhsal ve psikososyal farklılıklarının nedensellik açısından değerlendirilmesi
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Çocuğun cinsel istismarı henüz cinsel gelişimini tamamlamamış olan bir çocuğun ya da ergenin başka biri tarafından cinsel arzu ve ihtiyaçlarının tatmini amacıyla zor kullanılarak, kandırılarak veya tehdit yolu ile kullanılmasıdır. Cinsel istismar gelişiminde etkili olabilecek pek çok risk faktörü ve cinsel istismarın neden olduğu pek çok olumsuz ruhsal sonuç tanımlanmıştır.
Amaç: Bu çalışmada cinsel istismar mağduriyeti nedeniyle haklarında rapor düzenlenmesi amacıyla polikliniğimize adli birimlerce yönlendirilen çocuk ve ergen olguların sosyodemografik, klinik, ruhsal ve psikososyal özelliklerinin incelenmesi, bu özelliklerden hem cinsel istismar şiddetine yönelik hem de istismar sonrası oluşan olumsuz ruhsal sonuçlara yönelik risk etmenlerinin belirlenmesi ve uğranılan cinsel istismar şiddetine ait değişkenlerden istismar sonrası oluşan olumsuz ruhsal sonuçlara yönelik risk etmenlerinin saptanması amaçlanmıştır.
Yöntem: Ege Üniversitesi Tıp Fakültesi Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Anabilim Dalı adli polikliniğine 2014-2020 yılları arasında başvuru yapan 6-18 yaşları arasında olup çalışma kriterlerine uyan 340 cinsel istismar olgusunun dosyası geçmişe dönük olarak incelenmiştir. Olguların sosyodemografik, gelişimsel ve ailesel psikososyal özelliklerine yönelik bilgiler dosyalardan elde edilmiştir. Psikiyatrik tanılar DSM-5 kriterlerine göre adli tıp ve çocuk psikiyatrisi uzmanlarının yer aldığı adli konseyde konulmuştur. Olguların zeka düzeyleri zeka bölümü (Intelligence Quotient=IQ) puanları şeklinde Wechsler Çocuklar İçin Zeka Ölçeği-Revize Edilmiş Versiyonu ile ölçülmüş olup projektif test olarak olgulara Tematik Algı Testi uygulanmıştır. Olguların kaygı düzeyleri ebeveyn ve çocuk tarafından ayrı ayrı doldurulan Çocukluk Çağı Kaygı Bozuklukları Öz Bildirim Ölçeği (KAY-BÖ) ile, depresyon düzeyleri ise olguların doldurduğu Beck Depresyon Ölçeği (BDÖ) ve Çocuklar İçin Depresyon Ölçeği ile değerlendirilmiştir. Ayrıca olguların yaşamış olduğu cinsel istismarın şiddeti adli dosyalardan edinilen bilgiler doğrultusunda Cinsel İstismar Şiddeti Skoru (CİŞS) puanlaması ile ölçülmüştür. Bulgular: Olgularda yaş artışı daha olumsuz psikiyatrik sonuçlarla ilişkili saptanmıştır (p<0,05). Major depresif bozukluk (MDB) yaş artışıyla 1,018 kat artış göstermiştir (p=0,004). Ancak erkek cinsiyette MDB tanısı 0,383 oranında azalmaktadır (p=0,04). İlk kez istismara uğrama yaşının düşmesi ise daha olumsuz ruhsal sonuçlarla ilişkili saptanmamıştır (p>0,05). BDÖ puanları ve bazı KAY-BÖ alt ölçek puanları kızlarda daha yüksek saptanmıştır (p<0,05) ve kız cinsiyet bu ölçek puanlarındaki artışı yordamaktadır (p<0,05). Cinsel istismara uğrama ile adli polikliniğe başvuru arasındaki sürenin artışı genel örneklemde anksiyete ve depresyon bulgularında artışa ya da azalmaya yol açmasa da (p>0,05) özellikle ilaç tedavisi alan olgularda bu sürenin artışı anksiyete bulgularında azalmayla ilişkili saptanmıştır (r=-0,304 - -0,413; p<0,03). CİŞS-sözlü/fiziksel zorlanma (CİŞS-Z) (r=-0,150, p=0,005) ve CİŞS-niteliksel şiddet (r=-0,154, p=0,004) puanları total IQ puanları ile negatif yönde ilişkili saptanmıştır. Ailede şiddet ve kaotik aile ortamı cinsel istismar şiddetinde artışı yordamaktadır (sırasıyla p<0,04; p<0,05). Özellikle CİŞS-Z puanındaki artışın travma sonrası stres bozukluğu, MDB başta olmak üzere daha olumsuz ruhsal sonuçları yordadığı belirlenmiştir (p<0,03).
Tartışma: Çalışmamızdan elde edilen bulgular özellikle aile içi şiddet ve kaotik aile ortamının daha şiddetli düzeyde istismara uğramayla ilişkisini ve şiddetli düzeyde cinsel istismara uğramanın (özellikle sözlü/fiziksel zorlanma) olumsuz psikiyatrik sonuçlarla ilişkisini ortaya koymuştur. Geniş bir perspektifle nedensellik ilişkilerinin sunulduğu bu sonuçların gerek şiddetli cinsel istismarın gerekse de olumsuz psikiyatrik sonuçların oluşmasında daha etkili olan unsurları saptayarak ülkemizde cinsel istismara karşı daha etkili koruyucu müdahale stratejilerinin geliştirilmesine olanak sağlayacağı düşünülmektedir.
Introduction: Childhood sexual abuse is the exploitation of a child or adolescent who has not yet completed his/her sexual development by force, deceit, or threat to satisfy the perpetrator's sexual desires and needs. Many risk factors that may be effective in the development of sexual abuse and many negative mental consequences caused by sexual abuse have been identified. Objective: In this study, we aimed to evaluate sociodemographic, developmental, psychological and psychosocial characteristics of children and adolescents referred to our outpatient clinic in order to prepare reports due to sexual abuse victimization, to determine to determine the risk factors among those characteristics for both sexual abuse severity and negative psychological consequences, and to examine the risk factors of sexual abuse severity for negative psychological consequences. Method: The files of 340 sexual abuse cases, aged 6 to 18, who applied to the forensic outpatient clinic of Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry between 2014-2020 were retrospectively evaluated. Information about the sociodemographic, developmental, and familial psychosocial characteristics of the cases was obtained from the files. Psychiatric diagnoses were made according to DSM-5 criteria in the forensic council consisting of forensic medicine and child psychiatry specialists. Intelligence level was measured with the Wechsler Intelligence Scale for Children-Revised Version, and the Thematic Perception Test was applied to the cases as a projective test. Cases’ anxiety levels were evaluated via both parent- and self-reported Screen for Child Anxiety Related Emotional Disorders (SCARED), whereas the depression levels were evaluated with the Beck Depression Inventory (BDI) and the Children’s Depression Inventory, both of which were completed by the cases. In addition, sexual abuse severity was measured with the Sexual Abuse Severity Score (SASS) calculation in line with the information obtained from forensic files. Results: The age increase was found to be associated with more negative psychiatric outcomes (p<0.05). Major depressive disorder (MDD) probability increased 1.018 times with increasing age (p=0.004). However, MDD diagnosis decreased by 0.383 in male gender (p=0.04). The decrease in the age onset of sexual abuse was not found to be associated with more negative mental outcomes (p>0.05). BDI and some SCARED subscale scores were detected to be higher in girls than in boys (p<0,05) and female gender predicted elevated SCARED subscale scores and BDI scores (p<0.05). Although the increase in the time between sexual abuse and the application to the forensic clinic did not cause an increase or decrease in anxiety and depressive symptoms in general sample (p>0.05), the increase in this period was associated with the decrease in anxiety symptoms, especially in patients receiving medication (r=-0.304 - -0.413; p<0.03). The decrease in intelligence level was negatively associated with SASS-verbal/physical coercion scores (SASS-C) (r=-0.150, p=0.005) and SASS-qualitative severity scores (r=-0.154, p=0.004). Domestic violence and chaotic family environment predicted an increase in sexual abuse severity (p<0.04; p<0.05, respectively). It was also determined that elevated SASS-C scores predicted more negative mental outcomes, especially post-traumatic stress disorder and MDD (p<0.03). Discussion: The findings obtained from our study reveal the relationship between domestic violence, chaotic family environment, and more severe abuse, and the association between more severe sexual abuse (especially verbal/physical coercion) and negative psychiatric outcomes. It is considered that these results, which present causality relationships with a broad perspective, will enable the development of more effective protective intervention strategies against sexual abuse in our country by determining the factors causing both severe sexual abuse and negative psychiatric consequences.
Introduction: Childhood sexual abuse is the exploitation of a child or adolescent who has not yet completed his/her sexual development by force, deceit, or threat to satisfy the perpetrator's sexual desires and needs. Many risk factors that may be effective in the development of sexual abuse and many negative mental consequences caused by sexual abuse have been identified. Objective: In this study, we aimed to evaluate sociodemographic, developmental, psychological and psychosocial characteristics of children and adolescents referred to our outpatient clinic in order to prepare reports due to sexual abuse victimization, to determine to determine the risk factors among those characteristics for both sexual abuse severity and negative psychological consequences, and to examine the risk factors of sexual abuse severity for negative psychological consequences. Method: The files of 340 sexual abuse cases, aged 6 to 18, who applied to the forensic outpatient clinic of Ege University Faculty of Medicine, Department of Child and Adolescent Psychiatry between 2014-2020 were retrospectively evaluated. Information about the sociodemographic, developmental, and familial psychosocial characteristics of the cases was obtained from the files. Psychiatric diagnoses were made according to DSM-5 criteria in the forensic council consisting of forensic medicine and child psychiatry specialists. Intelligence level was measured with the Wechsler Intelligence Scale for Children-Revised Version, and the Thematic Perception Test was applied to the cases as a projective test. Cases’ anxiety levels were evaluated via both parent- and self-reported Screen for Child Anxiety Related Emotional Disorders (SCARED), whereas the depression levels were evaluated with the Beck Depression Inventory (BDI) and the Children’s Depression Inventory, both of which were completed by the cases. In addition, sexual abuse severity was measured with the Sexual Abuse Severity Score (SASS) calculation in line with the information obtained from forensic files. Results: The age increase was found to be associated with more negative psychiatric outcomes (p<0.05). Major depressive disorder (MDD) probability increased 1.018 times with increasing age (p=0.004). However, MDD diagnosis decreased by 0.383 in male gender (p=0.04). The decrease in the age onset of sexual abuse was not found to be associated with more negative mental outcomes (p>0.05). BDI and some SCARED subscale scores were detected to be higher in girls than in boys (p<0,05) and female gender predicted elevated SCARED subscale scores and BDI scores (p<0.05). Although the increase in the time between sexual abuse and the application to the forensic clinic did not cause an increase or decrease in anxiety and depressive symptoms in general sample (p>0.05), the increase in this period was associated with the decrease in anxiety symptoms, especially in patients receiving medication (r=-0.304 - -0.413; p<0.03). The decrease in intelligence level was negatively associated with SASS-verbal/physical coercion scores (SASS-C) (r=-0.150, p=0.005) and SASS-qualitative severity scores (r=-0.154, p=0.004). Domestic violence and chaotic family environment predicted an increase in sexual abuse severity (p<0.04; p<0.05, respectively). It was also determined that elevated SASS-C scores predicted more negative mental outcomes, especially post-traumatic stress disorder and MDD (p<0.03). Discussion: The findings obtained from our study reveal the relationship between domestic violence, chaotic family environment, and more severe abuse, and the association between more severe sexual abuse (especially verbal/physical coercion) and negative psychiatric outcomes. It is considered that these results, which present causality relationships with a broad perspective, will enable the development of more effective protective intervention strategies against sexual abuse in our country by determining the factors causing both severe sexual abuse and negative psychiatric consequences.
Açıklama
Anahtar Kelimeler
Cinsel İstismar, Cinsel İstismar Şiddeti, Nedensellik, Gelişimsel Psikoloji, Risk Faktörleri, Psikososyal Faktörler, Sexual Abuse, Sexual Abuse Severity, Causality, Developmental Psychology, Risk Factors, Psychosocial Factors
