Abstract
Childhood maltreatment is associated with risky sexual behaviors (RSBs). Previous systematic reviews and meta-analysis focused only on the relationship between childhood sexual abuse and RSBs, thus the association between childhood maltreatment and RSBs has yet to be systematically and quantitatively reviewed. We aimed to provide a systematic meta-analysis exploring the effect of childhood maltreatment and its subtypes on subsequent RSBs in adolescence and adulthood. PubMed, Google Scholar, EMBASE, Medline were searched for qualified articles up to April 2019. We calculated the pooled risk estimates using either the random-effect model or fixed-effect model. The potential heterogeneity moderators were identified by subgroup and sensitivity analysis. Overall, childhood maltreatment was significantly associated with an early sexual debut (odds ratio (OR) = 2.22; 95% confidence interval (CI): 1.64–3.00), multiple sexual partners (OR = 2.22; 95% CI: 1.78–2.76), transactional sex (OR = 3.05; 95% CI: 1.92–4.86) and unprotected sex (OR = 1.59; 95% CI: 1.22-2.09). Additionally, different types of childhood maltreatment were also significantly associated with higher risk of RSBs. Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results. Childhood maltreatment is significantly associated with risky sexual behaviors. The current meta-analysis indicates it is vital to protect children from any types of maltreatment and provide health education and support for maltreated individuals.
Highlights
Childhood maltreatment (CM) including neglect and emotional, sexual, and physical abuse has been recognized as a global public-health and social-welfare problem [1,2,3,4]
We identified studies satisfying the following criteria: (1) population-based observational quantitative studies; (2) studies reported subtype(s) of childhood maltreatment such as childhood sexual, physical or emotional abuse, and/or neglect; (3) studies reported the associations between a history of childhood maltreatment and any form of risky sexual behavior; (4) studies included participants of both genders and reported the outcomes of the total sample; and (5) studies reported the relative risks (RRs) and odd ratios (ORs), with corresponding 95% confidence intervals (CIs)
Evidence of heterogeneity was observed for childhood sexual abuse (CSA) (I2 = 74%; P < 0.01), CSA (OR = 3.24; 95% CI: 2.10–4.99) or childhood physical abuse (CPA) (OR = 1.86; 95% CI: 1.20–2.89) was associated with higher but not for CPA (I2 = 20%; P = 0.26) (Figure 5)
Summary
Childhood maltreatment (CM) including neglect and emotional, sexual, and physical abuse has been recognized as a global public-health and social-welfare problem [1,2,3,4]. It was reported that approximately 702,000 children were determined to be victims of childhood maltreatment nationally each year in the United States [5]. Among children aged 14–17 years in the USA, the estimated lifetime rate was 38.1% for childhood maltreatment, 18.1% for physical abuse, 23.9% for emotional abuse, 18.4% for neglect [2]. The estimated prevalence of childhood maltreatment among college students was 64.7% in China [6]. Research on the short- and long-term consequences of childhood maltreatment suggests that it substantially contributes to child mortality and morbidity, both internalizing and externalizing psychiatric disorders, criminal behaviors, substance use and risky sexual behavior in adolescence and adulthood [5,7,8,9,10]
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