Psychological Sequelae Research Articles

The use of ELMO helmets for the treatment of patients with COVID-19: experience report

Objective: to describe nurses' experience with the use of the ELMO helmet for the treatment of patients with COVID-19. Methods: experience report in an emergency care unit located in a metropolitan city of Ceará, Brazil, in the period from March 15 to June 22, 2021. Content Analysis was used for organization and analysis through references in the area. Results: the potentialities of care during the ELMO helmet use were observed, such as a decrease in indications for orotracheal intubation, improvement in respiratory distress, and decrease in morbidity, but also weaknesses such as diminished patient-healthcare professional communication, need for careful evaluation of the time of use and patient response, risk of psychological instability, and risk of broncho-aspiration; moreover, health teams collaborative aspects such as increased intra-team communication, effective interaction, and greater decision-making were registered. Conclusion: important results in treating COVID-19 can result from the use of this tool; however, there is a need for strict monitoring in order to avoid major respiratory complications as well as physical and psychological sequelae from the wearing of ELMO.

Investigating the Culture Around Sexual Harassment in First-Generation Universities in Southwestern Nigeria: Protocol for a Mixed Methods Study.

The phenomenon of sexual harassment (SH) is a complex issue with multiple prongs that concerns all members of academia and raises serious challenges, particularly regarding prevention and response. SH in tertiary institutions remains a huge problem worldwide, leading to severe emotional, academic, and career difficulties, as well as undue suffering. Institutions have responded in various ways to alleviate the burden of SH with little success, especially in Nigeria. The prevalence is high but reportage is low because of the culture of silence around SH in most educational institutions. This study aims to identify factors associated with SH in tertiary institutions in Nigeria and explore factors surrounding reportage or nonreportage following the experience of SH, the institutional mechanisms to prevent and respond to SH, and the lived experience of survivors of SH. The objective of this study was to present a study protocol that is designed to identify factors associated with the experience of SH in tertiary institutions in Nigeria, the institutional mechanisms to prevent and respond to SH, and the lived experience of survivors of SH. A mixed (quantitative and qualitative) methods approach is used consisting of a policy review of existing antisexual harassment policies in the selected universities, a quantitative survey to determine the correlates of SH, focus group discussions to explore the perspectives of the university community concerning SH, in-depth interviews to explore the lived experiences of survivors of SH, and key informant interviews to understand the perspectives of people who provide interventions to survivors. This study was funded in July 2022 by the Consortium for Advanced Research Training in Africa, and data collection started in November 2022. The SH policies were comprehensive, with clear policy statements and definitions, and recognized a wide range of survivors and perpetrators. However, there was no clear mention of prevention and response to same-sex SH. Lived experiences showed negative psychological and social sequelae and little institutional support. This is the first study that has a component investigating same-sex SH in tertiary institutions in Nigeria. This is also one of the first studies to explore the lived experiences of survivors of SH in Nigerian universities. The findings from this study suggest that periodic evaluation of SH policy implementation will improve institutional support, thus creating safe spaces for survivors and will thereby encourage reportage and support; prevention and response strategies need to be more inclusive; and more interventions should focus on strengthening prosocial skills and healthy, equitable relationships. DERR1-10.2196/49126.

Long-term burden of war injuries among civilians in LMICs: case of the July 2006 war in Lebanon.

Lebanon, a country located on the eastern shore of the Mediterranean Sea, is one of the world's smaller sovereign states. In the past few decades, Lebanon endured a perpetual political turmoil and several armed conflicts. July 12, 2006, marked the start of a one-month war in Lebanon, which resulted in thousands of casualties. Little is known about the long-term consequences of war injuries inflicted on civilians during the July 2006 war. The objectives of this paper were to identify and evaluate: 1- civilians' access to healthcare and medicine under conditions of war; 2- the long-term socioeconomic burden on injured civilians; and 3- their quality of life more than a decade post-war. We adopted a mixed-method research design with an emphasis on the qualitative component. We conducted interviews with patients, collected clinical and financial data from hospital medical records, and administered a self-rated health questionnaire, the EQ-5D-5L. Simple descriptive statistics were calculated using Excel. NVivo 12® was used for data management and thematic analysis. We conducted 25 interviews. Injured civilians were mostly males, average age of 27. The most common mechanism of injury was blast injury. Most patients underwent multiple surgeries as well as revision surgeries. The thematic analysis revealed three themes: 1- recall of the time of the incident, the thousand miles journey, and patients' access to services; 2- post-trauma sequelae and services; and 3- long-term impact. Patients described the long-term burden including chronic pain, poor mobility, anxiety or depression, and limited activities of daily living. Civilians injured during the July 2006 war described the traumatising events they endured during the war and the limited access to medical care during and post-war. Up until this study was conducted, affected civilians were still experiencing physical, psychological, and financial sequelae. Acknowledging the limitations of this study, which include a small sample size and recall bias, the findings underscore the necessity for the expansion of services catering to civilians injured during wartime.

Neurocognitive, Sociocultural, and Psychological Factors Impacting Medication Beliefs Among HIV-Seropositive Latinx Adults.

Among Latinx people living with HIV (PLWH), neurocognitive (NC) function, culture, and mental health impact medication adherence. Similarly, health beliefs and attitudes play a role in health care barriers and health behaviors. Research has not examined the effect that compromised neurocognition, sociocultural factors, and mental health have on health beliefs and attitudes. This is especially relevant for Latinx PLWH who are disproportionately impacted by HIV, given that sociocultural factors may uniquely impact HIV-related NC and psychological sequelae. This study investigated the associations between neurocognition, sociocultural factors, mental health, health beliefs, and health attitudes among Latinx HIV-seropositive adults. Within a sample of 100 Latinx PLWH, better verbal learning and executive functioning abilities were associated with more positive attitudes about the benefits of medications and memory for medications. In terms of sociocultural factors, higher English language competence was related to better self-reported memory for medications, and overall, higher US acculturation was associated with more positive attitudes toward health professionals. Depressive symptomatology was negatively associated with attitudes toward medications and health professionals, as well as with self-reported memory for medications. These findings highlight the important interplay between NC, sociocultural, psychological factors, and health beliefs among Latinx PLWH. Adherence intervention strategies and suggestions for dispensing medical information are presented for clinicians and health care practitioners.

Efficacy of an internet-based written imagery rescripting intervention for survivors of institutional childhood abuse – A randomized controlled trial

BackgroundInstitutional childhood abuse can have a long-term impact on the survivors' mental health, however, treatment for this group is limited and not always accessible. An internet-based intervention was developed, with the aim to reduce psychological sequelae relating to institutional abuse. ObjectiveThis study aimed to examine the efficacy of an online imagery rescripting intervention for survivors of institutional abuse, through assessing symptoms of depression, anxiety, PTSD, and CPTSD. Participants and settingSeventy-two adult survivors of institutional childhood abuse in the former German Democratic Republic were randomized either to the intervention (n = 38) or to the waitlist condition (n = 34). The intervention consisted of 10 modules, based on written imagery rescripting, and involved asynchronous therapist contact. MethodsPrimary outcomes included symptoms of depression (PHQ-9), anxiety (GAD-7), PTSD (ITQ), and CPTSD (ITQ DSO). The intervention condition was assessed at baseline, post-intervention, 3-, and 6-month follow-up. ResultsIntention-to-treat analyses revealed a significant symptom reduction from baseline to post-assessment with medium to large effects for all main outcomes (d = 0.45 to d = 0.76), in favor of the intervention condition. Significant interactions between condition (intervention vs. wailist) and time (baseline vs. post-assesment) were revealed for all main outcomes (p < .001 to p = .024). The effects were maintained at follow-up. ConclusionsThe results suggest online writing-based imagery rescripting as a promising treatment option for adults formerly institutionalized in residential care. Future research is needed to explore its effectiveness for other groups of patients suffering from abuse and neglect.

Wound healing, scarring and management.

Understanding wound healing is imperative for the dermatological physician to optimize surgical outcomes. Poor healing may result in negative functional, cosmetic and psychological sequelae. This review briefly outlines the physiology of wound healing, with a view to improving the management of wounds and scars, and minimizing the long-term scarring complications.

Women with Schizophrenia Have Difficulty Maintaining Healthy Diets for Themselves and Their Children: A Narrative Review.

Severe psychiatric disorders such as schizophrenia are inevitably linked to unemployment, meagre per capita income, and residence in disadvantaged, poorly resourced neighbourhoods. This means difficult access to healthy food and is particularly problematic for pregnant women and mothers with children to feed. The necessity of taking antipsychotic drugs is an additional barrier to healthy eating because these drugs are associated with serious cognitive, psychological, behavioural, and metabolic sequelae. Being ill with psychosis makes it extremely difficult to maintain a healthy diet; nutritional deficiencies result, as do medical complications. The results of present literature review confirm the gravity of the problem and suggest a number of potentially useful clinical interventions.

Stepped collaborative care versus American College of Surgeons Committee on Trauma required screening and referral for posttraumatic stress disorder: Clinical trial protocol

BackgroundEach year in the US, approximately 1.5–2.5 million individuals are so severely injured that they require inpatient hospital admissions. The American College of Surgeons Committee on Trauma (College) now requires that trauma centers have in place protocols to identify and refer hospitalized patients at risk injury psychological sequelae. Literature review revealed no investigations that have identified optimal screening, intervention, and referral procedures in the wake of the College requirement. MethodsThe single-site pragmatic trial investigation will individually randomize 424 patients (212 intervention and 212 control) to a brief stepped care intervention versus College required mental health screening and referral control conditions. Blinded follow-up interviews at 1-, 3-, 6-, and 12-months post-injury will assess the symptoms of PTSD and related comorbidity for all patients. The emergency department information exchange (EDIE) will be used to capture population-level automated emergency department and inpatient utilization data for the intent-to-treat sample. The investigation aims to test the primary hypotheses that intervention patients will demonstrate significant reductions in PTSD symptoms and emergency department/inpatient utilization when compared to control patients. The study incorporates a Rapid Assessment Procedure-Informed Clinical Ethnography (RAPICE) implementation process assessment. ConclusionsThe overarching goal of the investigation is to advance the sustainable delivery of high-quality trauma center mental health screening, intervention, and referral procedures for diverse injury survivors. An end-of-study policy summit will harness pragmatic trial data to inform the capacity for US trauma centers to implement high-quality acute care mental health screening, intervention and referral services for diverse injured patient populations.Trial Registration:Clinicaltrials.govNCT05632770

72 Neurocognitive and Emotional Symptoms of Pediatric Concussion Due to Physical Assault: A Case Series

Objective:Much of the pediatric concussion literature focuses on sports and recreation related injuries, while there is a relative paucity of research on the cognitive and psychological sequelae associated with assault. However, it is understood that children with assault-related injuries demonstrate a longer recovery time. This case series reviews the data of four teenagers who were administered cognitive, emotional, and behavioral screeners after sustaining an assault related concussion.Participants and Methods:Four pediatric female patients (ages 13,14,15,15) with a recent history of concussion due to physical assault presented for evaluation at a hospital-based concussion clinic. All four patients were administered a computerized cognitive screener as well as self-report measures for mood, anxiety, post-traumatic stress disorder (PTSD), and sleep disturbance.Results:All four of the pediatric cases reported significant symptoms of PTSD, depression, anxiety, and sleep disturbance. For all four patients, the most notable problems across cognitive performance measures were observed in the areas of simple and complex attention.Conclusions:Results of this case series revealed clinically significant anxiety, depression, PTSD-symptoms, and sleep disturbance in conjunction with poor simple and complex attention. These pediatric cases illustrate the potential link between assault-related concussions, emotional and behavioral symptoms, and cognitive functioning. Furthermore, assault-related concussions may elevate risk toward attentional problems associated with psychological distress. Early evaluation of PTSD and mood related symptomatology is suggested to best support treatment planning and recovery in this population. Future studies are needed to explore the nature of the relationship between cognitive and emotional sequelae in patients who present with assault-related concussions.

Is it really ever ‘just acne’? Considering the psychodermatology of acne

Abstract Acne can create a significant burden for people of all ages. However, the psychological consequences might often be overlooked. This review comments on recent evidence in the field of psychodermatology, to highlight the importance of considering a person's mental health in the treatment of acne. A range of presenting issues are discussed, and cases of underserved patients needing additional considerations are highlighted. This article considers how the psychological sequelae can contribute to the pathogenesis of acne, and discusses how psychotherapeutic approaches can be of benefit to people experiencing appearance-related distress. Importantly, attention is paid to the need for clinicians to assess a patient’s wellbeing alongside their physical symptoms. In doing this, early intervention can be facilitated if psychological comorbidities are present, with referral to appropriate specialist services, where available. To improve treatment outcomes, the skin and the mind must be addressed together in a multidisciplinary approach to dermatology care.

Psychological resilience to lifetime trauma and risk for cardiometabolic disease and mortality in older adults: A longitudinal cohort study

ObjectiveTrauma exposure is associated with risk for cardiometabolic disease and mortality, in part through negative psychological sequelae. In contrast, psychological resilience, showing positive psychological health despite experiencing trauma, may offset some of this risk. We examined longitudinal associations of psychological resilience to lifetime trauma and cardiometabolic outcomes and mortality in a large sample of older adults. MethodsUsing data from 6596 US Health and Retirement Study participants who had experienced lifetime trauma (mean age 64), we defined manifested psychological resilience based on trauma burden and psychological health (composite of low distress and high psychological well-being) through 2012. New onset cardiometabolic disease (heart problems, stroke, diabetes) and mortality were assessed across eight years of follow-up (through 2020). Repeated measures regressions determined associations between psychological resilience and outcomes over follow-up, adjusting for sociodemographic factors and prior disease. ResultsHigher levels of manifested psychological resilience were associated with lower risk for developing any cardiometabolic outcomes (relative risk for one SD higher resilience score, RR = 0.91, 95%CI 0.88–0.94) and for all-cause mortality (RR = 0.73, 95%CI 0.63, 0.86), adjusting for sociodemographic confounders. When examining individual diseases, resilience was significantly associated with lower risk for certain heart problems (i.e., congestive heart failure) and diabetes. Associations generally held when additionally adjusting for adult psychosocial and biobehavioral factors that could be potential pathway variables. ConclusionPsychological resilience to lifetime trauma may be linked to better cardiometabolic health even later in life. Promoting recovery and psychological resilience to trauma may be a target for more favorable health and longevity.

The Impact of Climate Change on Older Adults’ Mental Health: A Primer for Clinicians

Climate change is a major public health emergency. Natural disasters (earthquakes, floods, hurricanes, tornadoes, tsunamis, landslides, wildfires, and volcanic eruptions) have been increasing in frequency and severity and can cause lasting psychological sequelae. Older adults are highly vulnerable to the physical and mental health impacts of extreme weather and natural disasters. A narrative review was conducted to identify and summarize English-language articles focusing on the impact of climate change on older adults’ mental health. Sixty sources were identified. This review summarizes age-specific risk factors, clinical presentations (including anxiety, depressive, posttraumatic stress symptoms, and sleep disturbances), and management of psychiatric symptoms linked to climate change in the geriatric population. Older adults are highly vulnerable and can experience multiple mental health symptoms as a result of climate change. Clinicians should be aware and educated regarding the mental health impacts of climate change on older adults, so they can best support their patients.

Association between childhood adversities and premature and potentially avoidable mortality in adulthood: a population-based study

BackgroundThe association of childhood adversities with mortality has rarely been explored, and even less studied is the question of whether any excess mortality may be potentially preventable. This study examined the association between specific childhood adversities and premature and potentially avoidable mortality (PPAM) in adulthood in a representative sample of the general population. Also, we examined whether the associations were potentially mediated by various adult socioeconomic, psychosocial, and behavioral factors.MethodsThe study used data from the National Population Health Survey (NPHS-1994) linked to the Canadian Vital Statistics Database (CVSD 1994–2014) available from Statistics Canada. The NPHS interview retrospectively assessed childhood exposure to prolonged hospitalization, parental divorce, prolonged parental unemployment, prolonged trauma, parental problematic substance use, physical abuse, and being sent away from home for doing something wrong. An existing definition of PPAM, consisting of causes of death considered preventable or treatable before age 75, was used. Competing cause survival models were used to examine the associations of specific childhood adversities with PPAM in adulthood among respondents aged 18 to 74 years (rounded n = 11,035).ResultsDuring the 20-year follow-up, 5.4% of the sample died prematurely of a cause that was considered potentially avoidable. Childhood adversities had a differential effect on mortality. Physical abuse (age-adjusted sub-hazard ratio; SHR 1.44; 95% CI 1.03, 2.00) and being sent away from home (age-adjusted SHR 2.26; 95% CI 1.43,3.57) were significantly associated with PPAM. The associations were attenuated when adjusted for adulthood factors, namely smoking, poor perceived health, depression, low perceived social support, and low income, consistent with possible mediating effects. Other adversities under study were not associated with PPAM.ConclusionThe findings imply that the psychological sequelae of childhood physical abuse and being sent away from home and subsequent uptake of adverse health behavior may lead to increased risk of potentially avoidable mortality. The potential mediators identified offer directions for future research to perform causal mediation analyses with suitable data and identify interventions aimed at preventing premature mortality due to potentially avoidable causes. Other forms of adversities, mostly related to household dysfunction, may not be determinants of the distal health outcome of mortality.

Immersive virtual reality and psychological well-being in adult chronic physical illness: systematic review

IntroductionIndividuals with chronic physical illness are at increased risk of negative psychological sequelae. Immersive virtual reality (VR) is an emerging treatment that might reduce these negative effects and increase quality...

Immediate Surgical Obturator Prosthesis: Case Report

Resection of the maxilla often results in severe functional, aesthetic, and psychological sequelae. This loss of substance creates breaches that can extend throughout the palatal vault, affecting the maxillary sinus, the nasal cavities, the floor of the orbit, and even the orbital cavities. The prosthetic management of these patients is in fact a complex task involving several immediate, secondary, and definitive stages. The transition from one stage to the next depends on a number of factors, including the post-surgical follow-up and the stage of healing. This article discusses, through a case report, the importance of the immediate obturator in preventing post-operative complications and its role in protecting the surgical site during the initial healing period.

Virtual reality and noise canceling headphone distraction during pediatric dermatologic procedures.

Pain and anxiety related to medical procedures have long been recognized as a significant healthcare concern. If a patient's procedural pain and anxiety are not addressed, long-term physical and psychological sequelae including increased perceived pain, anxiety, disruptive behavior, trauma reactions, or refusal of future procedures can occur. The objective of our study was to assess the utility of a virtual reality (VR) headset or noise-canceling headphones (HP) compared to treatment as usual (TAU) in reducing pain and anxiety during pediatric dermatology procedures. Results indicated a significant difference between pre- versus post-procedure anxiety in the VR and HP groups but not the TAU group suggesting non-pharmacologic technology-based interventions such as VR and headphones may reduce patients' anxiety during pediatric dermatology procedures.

Moral injury and substance use among United States healthcare workers.

Moral injury (i.e., perpetrating, witnessing, failing to prevent, or being a victim of acts that transgress one's moral beliefs, values, or ethics) has largely been studied in military-connected populations and is associated with a range of adverse psychological sequelae. Emerging literature suggests that healthcare workers also experience moral injury, particularly in the context of the ongoing COVID-19 pandemic. However, it is not known if moral injury contributes to substance use among healthcare workers or whether these effects might differ by gender, race/ethnicity, or occupational level. In March 2022, we collected self-reported pilot data from a diverse sample of US healthcare workers (N=200) We examined the cross-sectional relationships between moral injury and several measures of substance use (i.e., current non-medical use of prescription drugs [NMUPD], current cannabis use, current use of other illicit drugs, and hazardous drinking) using separate logistic regression models. Next, we used separate interaction models to examine if any of these relations differed by gender, race/ethnicity, or occupational level. In main effects models, healthcare workers reporting greater moral injury had greater odds of current NMUPD (adjusted odds ratio (aOR)=1.07; p<0.001), current use of other illicit drugs (aOR=1.09; p<0.01), and hazardous drinking (aOR=1.07; p<0.01). These relations did not differ by race/ethnicity or occupational level (ps>0.05); however, men were more likely to report current NMUPD and hazardous drinking (ps<0.05) in the presence of high moral injury than women healthcare workers. Our findings suggest that healthcare workers experience substantial distress related to morally injurious events, which may affect their likelihood of NMUPD, cannabis use, use of other illicit drugs, and hazardous drinking, and that men in healthcare may be particularly at risk. Healthcare organizations should address systemic issues driving moral injury (e.g., resource shortages, lack of psychosocial support) to prevent substance-related harms among healthcare workers.

Follow-up after PICU discharge for patients with acquired brain injury: the role of an abbreviated neuropsychological evaluation and a return-to-school program.

To present the results of an abbreviated testing protocol used to screen for neurocognitive and psychological sequelae of critical illness among pediatric intensive care unit (PICU) survivors with acquired brain injury in our post-discharge follow-up programs, and describe our process for facilitating this population's return to academic life. Retrospective cohort study. Neurocritical care follow-up programs at two U.S. academic, tertiary medical/surgical PICUs. Children age > 4 years enrolled in the neurocritical care follow-up programs (n=289) at these institutions who underwent neurocognitive and psychological testing between 2017-2021. None. One month after discharge from the hospital, nearly half of the children and/or their parents (48%) in our neurocritical care follow-up programs identified some type of emotional or behavioral concern compared to their premorbid state, and 15% reported some type of cognitive concern. On evaluation, 35% of the children were given a new neurocognitive diagnosis. Neurocognitive domains regulated by the executive functioning system were the most commonly affected, including attention (54%), memory (31%) and processing speed (27%). One-quarter of the children were given a new psychological diagnosis, most commonly post-traumatic stress disorder (PTSD) or stress-related symptoms (12%). Over 80% of patients in the programs were given new recommendations for school, for both new academic services and new classroom accommodations. Over half of children (57%) were referred for comprehensive follow-up neuropsychological evaluation. Abbreviated neurocognitive and psychological evaluation successfully identifies the same deficits commonly found among PICU survivors who undergo longer, more complete testing protocols. When combined with services aimed at successfully re-integrating PICU survivors back to school, this focused evaluation can provide an effective and efficient means of screening for cognitive and emotional deficits among PICU survivors, and establish a rationale for early academic support upon the child's return to school.

Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach

BackgroundFalls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors can enable clinicians, researchers, and policymakers to clarify goals in falls intervention in older adults.MethodsA Group Model Building (GMB) exercise was conducted with researchers and clinicians from academic units and public healthcare institutes in Singapore. The aim of the exercise was to produce a shared visual representation of the causal structure for falls and engage in discussions on how current and future falls intervention programmes can address falls in the older adults, especially in the Asian context. It was conducted in four steps: 1) Outlining and prioritising desirable patient outcomes, 2) Conceptual model building, 3) Identifying key intervention elements of effective falls intervention programmes, 4) Mapping of interventions to outcomes. This causal loop diagram (CLD) was then used to generate insights into the current understanding of falls causal relationships, current efforts in falls intervention in Singapore, and used to identify gaps in falls research that could be further advanced in future intervention studies.ResultsFour patient outcomes were identified by the group as key in falls intervention: 1) Falls, 2) Injurious falls, 3) Fear of falling, and 4) Restricted mobility and life space. A CLD of the reciprocal relationships between risk factors and these outcomes are represented in four sub-models: 1) Fear of falling, 2) Injuries associated with falls, 3) Caregiver overprotectiveness, 4) Post-traumatic stress disorder and psychological resilience. Through this GMB exercise, the group gained the following insights: (1) Psychological sequelae of falls is an important falls intervention outcome. (2) The effects of family overprotectiveness, psychological resilience, and PTSD in exacerbating the consequences of falls are not well understood. (3) There is a need to develop multi-component falls interventions to address the multitude of falls and falls related sequelae.ConclusionThis work illustrates the potential of GMB to promote shared understanding of complex healthcare problems and to provide a roadmap for the development of more effective preventive actions.

Psychological aftereffects experienced by sexually abused children: Psychopathological characteristics revealed by the K-CBCL.

Children who have been sexually abused may experience various short- and long-term psychological sequelae and behavioral problems. This study assessed the mental health of sexually abused children using the Korean-Child Behavior Checklist (K-CBCL) and examined differences from a control group. The participants were 97 children who had been sexually abused and who visited a local Sunflower Center, and 178 control participants. Data were collected via the K-CBCL and analyzed using SPSS version 25.0. T-tests, cross-tabulation, and logistic regression analyses were performed. Scores from the K-CBCL Problem Behavior Syndrome scale were compared between sexually abused children and the control participants. Significant differences were observed between the 2 groups in all the subscales. Compared to the control group, children who were sexually abused showed statistically significant differences in the total problem behavior, internalization, anxiety/depression, withdrawal/depression (withdrawn), somatic symptoms, externalization, rule-breaking behavior (delinquency), aggressive behavior, social immaturity, thought problems, attention problems, and other subscale scores. Sexual violence hurts the overall mental health of children who are abused, including their emotional, behavioral, and social factors. Our findings suggest that multidisciplinary assessment and treatment are required for children who have experienced sexual abuse.