Legal and secondary biopsychosocial outcomes of child sexual abuse: Experience from a hospital-based multidisciplinary child protection unit in an urban lower-middle income country setting

Abstract

BackgroundChild sexual abuse (CSA) is prevalent in the Philippines. The Philippine General Hospital–Child Protection Unit (PGH-CPU) provides multidisciplinary management. Local literature on legal and secondary biopsychosocial outcomes of CSA is limited. ObjectiveDetermine legal and biopsychosocial outcomes among CSA survivors and determine factors associated with reaching court and perpetrator conviction. ParticipantsCSA survivors evaluated at the PGH-CPU in 2009–2013. MethodsA mixed transdisciplinary design to obtain data from medical records, court documents, and interviews of study participants and key informants. ResultsFactors associated with CSA cases reaching court were having multiple perpetrators (OR 5.26, 95% CI 1.45–19.05, p = 0.011) and an age difference of more than 10 years between child and perpetrator (OR 2.51, 95% CI 1.26–5.01, p = 0.009). A 10-year age difference between child and perpetrator was a significant determinant for conviction (OR 3.69, 95% CI 1.04–13.14, p = 0.044). Interviews showed that the child's testimony is the most significant factor for successful prosecution. CSA survivors have increased risks for negative biopsychosocial outcomes. Children who followed-up at PGH-CPU showed a significantly lower rate of suicide attempts (0% vs. 7.7% in children without follow-up, p = 0.023) and had lower odds of having multiple sexual partners (OR 0.12, 95% CI 0.03–0.49, p = 0.003) and being employed (OR 0.23, 95% CI 0.07–069, p = 0.009). ConclusionsThere is a need to strengthen capacities of professionals to optimize legal processes and outcomes. CSA survivors have varied long-term outcomes requiring continued holistic aftercare interventions.