Child sexual abuse, disclosure and PTSD: A systematic and critical review

Background: Child sexual abuse (CSA) is a prevalent exposure with potentially serious, negative health consequences, including post-traumatic stress disorder (PTSD) and its symptomatology. Objective: To conduct a systematic and critical review in order to investigate the relationship between CSA disclosure patterns and PTSD. Participants and setting: Studies included clinical, college and community-based samples of adults' and children's experiences of CSA. Methods: We conducted systematic searches in five databases (Medline, Embase, PyscINFO, CINAHL, ERIC, Sociological Abstracts) from database inception to October 17, 2017 using index terms and keywords for CSA, disclosure, and PTSD. We included any English-language, primary studies involving children or adults with experiences of CSA that used quantitative research designs to explore the relationship between disclosure and PTSD. We used systematic critical review methodology in order to investigate the relationship between disclosure and PTSD symptoms and disorders. We also investigated factors that explained the relationship between disclosure and PTSD, such as individual, exposure or environmental factors. Results: Twenty-two articles reporting 20 studies were included in this review. Studies assessing the relationship between CSA and PTSD tended to account for personal (e.g., gender) and CSA exposure variables (e.g., severity of CSA) only. While authors generally used validated measures to assess for PTSD symptoms and disorders, they tended to use author-generated or unvalidated measures to assess for disclosure process variables. Conclusion: The relationship between factors that affect disclosure, and responses to disclosure, are not well theorized in quantitative literature. Study findings suggest important avenues for future research, such as the need to assess disclosure longitudinally.