5 YEARS AFTER CHILD SEXUAL ABUSE - PERSISTING DYSFUNCTION AND PROBLEMS OF PREDICTION

Objective: To assess change in behavior, depression, and self-esteem i n sexually abused children after 5 years and to determine which factor s predict later functioning. Method: Sixty-eight of 84 children and th eir nonoffending parents were reassessed after 5 years for depression, self-esteem, and behavior problems in the children; parental mental h ealth; and family functioning. Results: There were no significant chan ges in depression, self-esteem, or behavior over 5 years. Forty-three percent of the children were now sad or depressed, 43% had low self-es teem, and 46% had behavioral dysfunction. While some children improved , a nearly equal number deteriorated, with no clear pattern of change. The only abuse-related variables associated with 5-year functioning w ere further contact with the abuser, which was significantly associate d with depression and self-esteem and sexual abuse prior to intake, wh ich was related to an increased incidence of behavior problems. Older children showed more depression and lower self-esteem but less behavio ral dysfunction. Poor family functioning at 5 years was associated wit h low self-esteem and behavior problems. Treatment had no effect on de pression, self-esteem, or behavior. Multivariate analysis showed that depression and self-esteem at intake were prognostic indicators of 5-y ear outcome. Conclusion: Many sexually abused children have continuing problems with behavior, self-esteem, and depression. Family and abuse -related variables do not appear to be good predictors of outcome, alt hough sexually abused children who are sad or depressed and have low s elf-esteem at intake are likely to have continuing problems in these a reas.