Sexual victimization in minors and mental health issues

Abstract

Introduction

Sexual victimization in children and adolescents is a serious form of child abuse that violates the rights of children and adolescents, and that can lead to negative consequences for their mental health. The present research tries to analyze the relation existing between being a victim of sexual violence and mental health problems.

Method

A total of 519 students participated, aged between 10 and 18 years (M = 12.49; SD = 1.949), belonging to primary and secondary schools, 246 were female (47.39%), and 273 (52.60%) were male. The Sexual Violence Questionnaire-Victim Version (SVQ-VV) was used to assess different types of sexual violence (physical, verbal and cyber violence) and the Strengths and Difficulties Questionnaire, SDQ - self-report version for mental health problems.

Results

The results indicate that sexual violence against children is associated with certain mental health problems, both internalizing and externalizing. Furthermore, the likelihood of encountering externalizing problems is twice as high in minors who are victims of physical sexual violences.

Conclusions

This research sheds light on the dynamics of sexual violence against children and adolescents, providing relevant information on the relationship between the type of sexual violence and its consequences on the victim’s mental health. The findings highlight the importance of early detection and differentiated interventions in child and adolescent victims of sexual violence. Preventive policies and multidisciplinary support programs are crucial to mitigate the long-term psychological consequences of sexual violence. Therefore, given the current situation regarding this issue, we believe that training professionals in the detection of different forms of sexual violence is crucial to providing appropriate intervention responses concerning victims’ mental health.

Introduction

Sexual violence

The phenomenon of sexual violence includes concepts referring to sexual abuse, sexual assault, or sexual harassment, among others. Sexual violence against minors is any contact and/or sexual activity between a child or adolescent and another person, whether an adult or a minor, who holds a position of power over them without their consent. This may involve threats, deception, physical or psychological violence, cyber-assault, or psychological manipulation through seduction by offering some kind of reward, thereby ensuring the victim’s silence [1–5]. In Spain, the data published by the Spanish Home Office [6] indicate that 827 minores aged 14–17 were arrested in 2021 for crimes against sexual privacy, being mostly (97%) male [7]. Likewise, from January to September 2022, 13,437 crimes against sexual freedom were registered in total, while one year later in the same period, those crimes increased by 12%, reaching 15,051 cases [8]. A study elaborated by Save the Children in 2021 [9] states that, in Spain, between 10 and 20% of children and adolescents have suffered sexual abuse, mainly females.

Sexual violence includes sexual contact but also indirect contact activities such as indecent exposure, exposure of minors to pornographic material online, harassment and cyber-harassment, sexting, grooming, or use of children for producing sex-related visual material, or the invasion of the minor’s privacy [10, 11]. Other acts may go unnoticed, such as gestures, phrases, or degrading language, as some take subtle forms of violence that are not recognized or interpreted as sexual violence [12, 13]. A common factor in these acts is that they occur without the explicit consent of one party—the victim—since they take place within a relationship of power abuse. In some cases, the victims themselves are unaware of these acts, either due to their age or because they are under the influence of psychoactive substances. This results in physical and/or psychological harm, with significant consequences for the victims’ mental health [1, 6, 9, 13]. Sexual violence has severe repercussions not only for those who directly experience it but also for society as a whole. For this reason, it is considered a public health issue that violates universal fundamental rights [1, 2, 14–19].

Mental health

Mental well-being in childhood and adolescence has become a global concern due to growing evidence in recent years of an increase in mental disorders among children and adolescents. These mental health issues are linked to experiences of suffering, poor academic performance, disability, and functional deterioration [20]. The World Health Organization (WHO) [21] defines mental health as a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well, and work well, and contribute to their community. Thus, mental health is considered an emerging need of children and adolescents, identifying the risk factors that could be linked to the development of internalizing and externalizing problems [22–25]. Family could act as both a risk or a protection factor face to children and adolescents’ mental health problems, together with social relationships that also play an important role [20, 25–27]. During childhood and adolescence, they will develop a series of social competences that allow children and adolescents an adequate belonging in the peer group, which takes the place of the reference axis, and it is in this context of interaction among peers and introduction to sexuality, when may be the first situations of sex violence start occurring [28].

Among the consequences for mental health of minors suffering from sexual violence, we find physical, emotional, social, and behavioral problems, which will affect their psychological and mental adaptation, both in the short and in the middle term. Not diminishing the physical consequences, the psychological effects may be the most worrying. Among the internalizing problems we can find fear, hatred, humiliation, higher vulnerability, low self-esteem, insecurity, or emotional instability, anxiety disorders, mood disorders, dissociative disorders, or post-traumatic stress disorders, which will accompany the victim for several years [1, 2, 17, 29]. When sexual victimization occurs through new technologies, the victims can suffer other consequences such as defenselessness, paranoid symptoms, and revictimization, due to the quick diffusion and the unlimited audience [30]. The victims can also incriminate themselves and feel embarrassed by the possible active part in the dynamics (exchanging intimate pictures, for example) or the impossibility to delete the images or evidence of abuse [31, 32].

All this can lead to an externalizing symptomatology which manifests in behavioral shifting of the victims, with a harmful effect on them by avoiding any kind of social interaction, exposure to risky behavior, substance consumption, eating disorders, or even initiating risky sexual behaviors [30, 33, 34]. Self-harm and/or suicidal behaviors are also common in people who have suffered from sexual violence as an escape from their situation [34–36]. To sum up, sexual victimization in childhood and adolescence can have harmful effects affecting their development, mental health, and well-being. Our goal for this research is to study the relationship existing between being a victim of violence and mental health problems among primary education children and secondary education adolescents. To this end, we established two specific objectives. First, given the lack of instruments aimed at assessing sexual violence in minors that allow for the early identification of warning signs, and building on previous studies [3, 9], we developed a questionnaire on sexual violence against children and adolescents, using clear, age-appropriate language, and analyzed its psychometric properties.

Secondly, we aimed to analyze the factors of sexual violence that influence the likelihood of experiencing different internalizing and externalizing problems among minors.

Methods

Considering the objectives of this research, we studied a phenomenon that had already occurred at a specific point in time without continuity, and we did not manipulate the variables under study. Given these conditions, an ex post facto cross-sectional research design is applied. The primary objective of our study is to analyze the relationship between being a victim of violence and mental health problems among primary school children and secondary school adolescents. For this purpose, we employed an associative strategy, primarily through multinomial regression analysis.

Participants

Participants were selected through cluster sampling and random selection in educational centers that offered 5th and 6th grades of Primary Education and Secondary Education. Cluster sampling was conducted by randomly selecting 15 educational centers in Extremadura (Spain).

Considering a 95% confidence interval and a ± 5% margin of error, a total of 519 students participated, belonging to 7 secondary schools and eight primary schools. As for gender, 246 students were female (47.39%). The primary education students totaled 267, with 5th grade (N = 158; 59.17%) and 6th grade (N = 109; 40.82%). As for Compulsory Secondary Education (ESO) students, there were a total of 252, distributed as follows: 1 st year of ESO (N = 50; 19.84%), 2nd year of ESO (N = 52; 20.63%), 3rd year of ESO (N = 109; 43.25%), and 4th year of ESO (N = 41; 16.26%). The participants’ ages ranged from 10 to 18 years (M = 12.49; SD = 1.949). None of the participants had any recorded experience of sexual violence.

Measures

Sexual Violence Questionnaire-Victim Version

 This is a questionnaire created by the authors for this research, designed to assess sexual violence against children and adolescents, any form of sexual contact or activity committed by adults or by other minors against them through coercion. The questions include 12 items that refer to types of sexual violence behaviors, classified into: physical behaviors of a sexual nature, verbal behaviors of a sexual nature (catcalling, insinuations, obscene communications, etc.), physical contact (touching, use of force, etc.), and cyber sexual violence. The frequency of being a victim of sexual violence is assessed using an ordinal scale with four categories: (1 = never, 2 = sometimes, 3 = often, and 4 = always).

Strengths and difficulties questionnaire, SDQ - goodman’s self-report version [37]

SDQ-Self-Report Version

is a brief instrument with outstanding internal consistency across all its scales, both internationally and in its Spanish version. It consists of 25 items divided into five dimensions or subscales: (1) Emotional Problems, (2) Behavioral Problems, (3) Peer Problems, (4) Hyperactivity, and (5) Prosocial Behavior. Each subscale is assessed through five items. The response format follows a 3-point Likert scale (0 = No, not at all; 1 = Sometimes; 2 = Yes, always).

For community samples, it is recommended to group the items from the Behavioral Problems subscale and the Hyperactivity subscale into a new scale called Externalizing Problems [20]. Similarly, the items from the Emotional Symptoms subscale and the Peer Problems subscale are combined to create the Internalizing Problems scale.

In our study, the reliability indexes were as follows: Total SDQ score, Cronbach’s alpha (α = 0.83), McDonald’s omega (Ω = 0.85); Internalizing Problems, Cronbach’s alpha (α = 0.80), McDonald’s omega (Ω = 0.80); Externalizing Problems, Cronbach’s alpha (α = 0.70), McDonald’s omega (Ω = 0.73).

To determine whether the scales used adequately fit our data, we applied the goodness-of-fit indexes described in Table 1. As shown, these fit indexes approximate the desirable values, providing evidence of validity for the generalization of our results.

Table 1.

Goodness-of-fit indexes for strengths and difficulties Questionnaire, SDQ - Self-Report Version

Model		χ2	χ2/df	GFI	IFI	TLI	CFI	RMSR	RMSEA
2 factors		99.272	2.919	0.983	0.919	0.891	0.918	0.050	0.087

χ2 = Chi-square statistic; χ2/df = Chi-square divided by degrees of freedom; GFI = Goodness of Fit Index; IFI = Incremental Fit index; TLI = Tucker–Lewis Index; CFI = Comparative Fit Index; RMSR = Root Mean Square Residual; RMSEA = Root Mean Square Error of Approximation

Procedure

This research was approved by the Comisión de Bioética y Bioseguridad (Bioethics and Biosecurity Committee) at Universidad de Extremadura (No. 197/2024). Besides, we followed the ethical principles of the American Psychological Association [38] regarding the parents’ informed consent since the participants were minors. Firstly, we contacted the educational centers in order to explain the research’s goals and to ask for permission to fill in the questionnaires. The procedure consisted in handing the online questionnaire to each classroom group under the supervision of the teacher and a researcher responsible for the study, after having explained the objectives of the study to the students. Likewise, we guaranteed anonymity in the responses, confidentiality of the collected data, and exclusive use for research purposes. The questionnaire was handed out online during school hours via Google Forms, with a duration of 20 min approximately, in an adequate environment without any distractions. Everyone agreed to participate.

Data analysis

Initially, to construct and analyze the psychometric properties of the Sexual Violence Questionnaire—Victim Version (SVQ-VV), an exploratory factor analysis (EFA) was conducted. After performing the EFA, the factorial structure found was confirmed through a confirmatory factor analysis (CFA). The reliability of the questionnaire’s factors was calculated using Cronbach’s alpha and McDonald’s omega coefficients.

Regarding the Strengths and Difficulties Questionnaire (SDQ)—Self-Report Version by Goodman (1997), reliability analyses (Cronbach’s alpha and McDonald’s omega) and confirmatory analyses were conducted to determine whether its conceptual structure, as described in the original studies, adequately fit our data.

Subsequently, two statistical analyses were conducted in the study:

1. ANOVAs with partial eta-squared effect size test. The data were subjected to the Kolmogorov-Smirnov test to assess normal distribution, yielding p >.05, indicating normality for all observed variables. Similarly, the p >.05 result from Levene’s test demonstrated the equality of variances across groups.

2. To expand upon the information obtained from the ANOVA, a multinomial logistic regression analysis was performed. This analysis made it possible to determine which factors from the Sexual Violence Questionnaire–Victim significantly predicted levels of internalizing and externalizing problems. Furthermore, it allowed for a better understanding of how different predictors influenced the probability of belonging to the high or medium levels of internalizing and externalizing problems, calculating odds ratios. In this analysis, internalizing and externalizing problems were included as predictor variables, categorized into three levels based on percentile criteria: low (<33%), medium (33%−66%), and high (>66%). As independent and predictor variables the factors from the Sexual Violence Questionnaire. The statistical analyses were conducted using SPSS version 27.0 for PC and Free JASP.

Results

Psychometric analysis of Sexual Violence Questionnaire-Victim Version

In order to analyze the psychometric features of the Sexual Violence Questionnaire-Victim Version, the original sample (n = 519) was divided into two subsamples randomly extracted (n₁ = 266 and n₂ = 253). The first one (n₁) was used to carry out an Exploratory Factor Analysis (EFA), and the second one (n₂) was a validation sample in a Confirmatory Factor Analysis (CFA).

Regarding the EFA, the measure of sampling adequacy (KMO = 0.847) and Bartlett’s test of sphericity (χ² = 2257.834(66), p <.001) justified the factorial analysis. A three-factor solution was obtained using Kaiser’s rule (1960) with eigenvalues greater than one and the unweighted least squares extraction method with Oblimin rotation (Table 2), collectively explaining 62.8% of the variance. The first factor, Victim of verbal sexual violence - VSV (4 items), explained 40.8% of the variance. The second factor, Victim of physical sexual violence - PSV (3 items), accounted for 12.3% of the variance, and the third factor, Victim of cyber sexual violence - CySV (5 items), explained 9% of the variance.

Table 2.

Exploratory factor analysis of “Sexual violence Questionnaire-Victim Version”

	Components			Communalities
	1	2	3
I receive obscene sexual comments through phone calls, face-to-face interactions, or written messages (paper, graffiti, etc.)	0.803	0.186	0.523	0.696
I am given sexualized compliments that make me feel uncomfortable.	0.785	0.407	0.288	0.644
I receive sexual proposals or insinuations that bother me.	0.759	0.479	0.298	0.635
I am forced to listen to sexual conversations that make me feel uncomfortable or disgusted.	0.742	0.339	0.285	0.561
I am touched or brushed on intimate areas of my body without my consent.	0.337	0.861	0.276	0.692
I am touched, brushed against, pinched, or caressed in a way that makes me feel uncomfortable.	0.346	0.829	0.219	0.751
I am given hugs or kisses seeking sexual closeness without my consent.	0.459	0.670	0.329	0.521
I receive (through the Internet or mobile phone) text messages, images, or videos with explicit sexual content without requesting them.	0.419	0.047	0.788	0.653
I have interacted with an adult through social media who pretended to be my age to achieve sexual closeness.	0.179	0.304	0.759	0.639
I receive obscene sexual comments through social media, emails, etc.	0.474	0.214	0.733	0.570
Intimate photographs (of my body or of me engaging in sexual activities with another person) are shared without my consent.	0.385	0.307	0.629	0.434
I am photographed or recorded in videos with sexual content without my knowledge or consent.	0.408	0.097	0.612	0.651
Extraction Method: Maximum Likelihood.
Rotation Method: Oblimin.

The reliability indexes were as follows: Total SVQ-VV score, Cronbach’s alpha (α = 0.86), McDonald’s omega (Ω = 0.87); VSV Factor, Cronbach’s alpha (α = 0.78), McDonald’s omega (Ω = 0.80); PSV Factor, Cronbach’s alpha (α = 0.73), McDonald’s omega (Ω = 0.74); CySV Factor, Cronbach’s alpha (α = 0.77), McDonald’s omega (Ω = 0.78). These indexes show good internal consistency.

The CFA of the questionnaire was conducted with the second subsample (n₂ = 253) to confirm the three-factor structure found in the EFA. Considering some of the most commonly used fit indexes (χ², χ²/df, GFI, IFI, TLI, CFI, RMSR, and RMSEA), Table 3 shows that these fit indexes approximate the desirable values, providing evidence of validity for the generalization of our results.

Table 3.

Goodness of fit indexes for the proposed model: sexual violence Questionnaire-Victim version (SVQ-VV)

Model		χ2	χ2/df	GFI	IFI	TLI	CFI	RMSR	RMSEA
3 factors		99.296	3.103	0.988	0.933	0.904	0.932	0.066	0.093

χ2 = Chi-square statistic; χ2/df = Chi-square divided by degrees of freedom; GFI = Goodness of Fit Index; IFI = Incremental Fit index; TLI = Tucker–Lewis Index; CFI = Comparative Fit Index; RMSR = Root Mean Square Residual; RMSEA = Root Mean Square Error of Approximation

Sexual violence victim factors for predicting levels of internalizing problems: multinomial regression analysis

First, we examined the possible existence of differences among the means of the three levels of internalizing problems and the scores on the factors of the Sexual Violence Questionnaire-Victim Version by performing an analysis of variance (ANOVA). In Table 4, we can see the means and standard deviations, where it can be observed that students with a high level of internalizing problems have obtained higher mean scores than those of medium and low levels in all factors of the SVQ-VV.

Table 4.

Results of ANOVA test, Means, and standard deviation of the sexual violence Questionnaire-Victim version factors according to the different levels of suffering from internalizing problems

	Levels of Suffering from Mental Health Internalizing Problems				ANOVA Test
Sexual Violence Victim Factors	Low level M(SD)	Medium level M(SD)	High level M(SD)	F	p	ƞ2*
VSV	4.17 (0.74)	4.18 (0.75)	4.71 (1.98)	9.49	0.000	0.037
PSV	3.29 (1.29)	3.2 (0.55)	3.69 (1.52)	8.92	0.000	0.034
CySV	5.05 (0.30)	5.15 (0.76)	5.40 (1.42)	6.31	0.002	0.025

Sexual Violence Factors: (1) Victim of verbal sexual violences (VSV); (2) Victim of physical sexual violences (PSV); (3) Victim of cyber sexual violences (CySV)

*Partial eta-squared effect size test: If 0.06 ≤ η² < 0.14, the effect is moderate; if η² ≥ 0.14, the effect is strong

Significant differences were found between the three levels of internalizing problems for the following factors: Victim of verbal sexual violences, VSV (F = 9.49, p <.000); Victim of physical sexual violences, PSV (F = 8.92, p <.000); Victim of cyber sexual violences (CySV) (F = 6.31, p <.002). The values of the effect size—partial eta-squared—were medium-low.

Finally, the multinomial regression analysis showed a satisfactory fit (χ² = 32.496(6), p <.001; R Nagelkerke = 0.074), allowing a correct classification of 50.3% of the cases. As we can see in Table 5, for the model outcome with the reference category low level of internalizing problems, the parameter estimates reveal that the factor Victim of cyber sexual violence is significantly and directly associated with the medium level of internalizing problems (B = 0.684, p <.05) and with the high level of internalizing problems (B = 0.698, p <.05). The OR estimates of the model report that the likelihood of having a medium level of internalizing problems is 1.982 times higher in those students who are victims of cyber sexual violence and 2.011 of having a high level of internalizing problems.

Table 5.

Results of the multinomial logistic regression analysis for predicting levels of internalizing problems

	Medium level of internalizing problems1				High level of internalizing problems1
	B	OR	IC 95%		B	OR	IC 95%
VSV	− 0.120	0.887	0.610	1.291	0.189	1.208	0.900	1.623
PSV	− 0.181	0.835	0.603	1.156	0.129	1.138	0.898	1.441
CySV	0.684*	1.982	1.060	3.704	0.698*	2.011	1.088	3.716

Sexual Violence Factors: (1) Victim of verbal sexual violences (VSV); (2) Victim of physical sexual violences (PSV); (3) Victim of cyber sexual violences (CySV)

Reference category:¹Low level of internalizing problems.*p< 05

Sexual violence victim factors for predicting levels of externalizing problems: multinomial regression analysis

First, we examined the possible existence of differences among the means of the three levels of externalizing problems and the scores on the factors of the Sexual Violence Questionnaire-Victim Version by performing an analysis of variance (ANOVA). In Table 6, we can see the means and standard deviations, where it can be observed that students with a high level of externalizing problems have obtained higher mean scores than the group of students of medium and low levels in all factors of the SVQ-VV.

Table 6.

Results of ANOVA test, Means, and standard deviation of the sexual violence Questionnaire-Victim version factors according to the different levels of suffering from externalizing problems

	Levels of Suffering from Mental Health Externalizing Problems				ANOVA Test
Sexual Violence Victim Factors	Low level M(SD)	Medium level M(SD)	High level M(SD)	F	p	ƞ2*
VSV	4.17 (0.62)	4.25 (0.95)	4.56 (1.81)	4.55	0.011	0.018
PSV	3.10 (0.38)	3.32 (0.98)	3.67 (1.53)	11.49	0.000	0.043
CySV	5.09 (0.42)	5.11 (0.43)	5.35 (1.43)	4.14	0.016	0.016

Sexual Violence Factors: (1) Victim of verbal sexual violences (VSV); (2) Victim of physical sexual violences (PSV); (3) Victim of cyber sexual violences (CySV)

*Partial eta-squared effect size test: If 0.06 ≤ η² < 0.14, the effect is moderate; if η² ≥ 0.14, the effect is strong

Significant differences were found between the three levels of externalizing problems for the following factors: Victim of verbal sexual violences, VSV (F = 4.55, p <.011); Victim of physical sexual violences, PSV (F = 11.49, p <.000); Victim of cyber sexual violences (CySV) (F = 4.14, p <.016). The values of the effect size—partial eta-squared—were medium-low.

Finally, the multinomial regression analysis showed a satisfactory fit (χ² = 29.489(6), p <.000; R Nagelkerke = 0.067), allowing a correct classification of 50% of the cases. As we can see in Table 7, for the model outcome with the reference category low level of externalizing problems, the parameter estimates reveal that the factor Victim of physical sexual violence is significantly and directly associated with the medium level of externalizing problems (B = 0.557, p <.05) and with the high level of externalizing problems (B = 0.749, p <.001). The OR estimates of the model report that the likelihood of having a medium level of externalizing problems is 1.745 times higher in those students who are victims of physical sexual violence and 2.115 of having a high level of externalizing problems.

Table 7.

Results of the multinomial logistic regression analysis for predicting levels of externalizing problems

	Medium level of externalizing problems1				High level of externalizing problems1
	B	OR	IC 95%		B	OR	IC 95%
VSV	0.004	1.004	0.746	1.350	− 0.021	0.979	0.740	1.296
PSV	0.557*	1.745	1.099	2.770	0.749**	2.115	1.346	3.323
CySV	0.048	1.049	0.605	1.817	0.370	1.447	0.884	2.369

Sexual Violence Factors: (1) Victim of verbal sexual violences (VSV); (2) Victim of physical sexual violences (PSV); (3) Victim of cyber sexual violences (CySV)

Reference category:¹Low level of externalizing problems. **p< 001 *p< 05

Discussion

Childhood and adolescence are crucial stages when it comes to the issue of sexual violence. Regarding sexual victimization, certain studies indicate a higher risk of mental health problems due to cumulative exposure to traumatic events of this nature [39]. The analysis of children and adolescents’ mental health in relation to the risk of emotional disorders or behavioral problems has become a topic of global research interest and a priority for public health policies. Knowing and understanding the impact of experiencing sexual violence on children and adolescents’ mental health is a crucial step in addressing their needs. Children and adolescents may be particularly vulnerable to negative mental health consequences, as they may have limited coping skills. The present study aims to analyze the relationship between being a victim of sexual violence and mental health problems among primary education children and secondary education adolescents.

To achieve our objective in this study and ensure the generalizability of our results, we first assessed the reliability and validity of the Sexual Violence Questionnaire - Victim Version (SVQ-VV). The results of the exploratory and confirmatory factor analyses revealed an appropriate factorial structure, internal consistency, and validity of the instrument. Thus, this research provides a scientifically rigorous instrument with adequate validity and reliability for assessing sexual violence against children and adolescents.

Regarding the Strengths and Difficulties Questionnaire (SDQ), the factorial models found in the original studies adequately fit our data. The indices approach the desirable optimal values, providing evidence of reliability and validity.

The findings indicate that sexual violence is associated with certain mental health problems, as children and adolescents in the sample exhibit both internalizing and externalizing mental health issues. These results are consistent with previous studies that have found associations between sexual violence and adolescent mental health, showing that the latter is negatively affected in the presence of the former [40–43].

This research provides a typology of sexual violence based on physical, verbal, and non-verbal behaviors, as well as cyber sexual violence. Additionally, it delves into the association between these types of violence and mental health problems, specifically internalizing and externalizing issues. The results indicate that students with a high level of internalizing problems obtained higher mean scores than those in the medium- and low-level groups across all subscales. Thus, experiencing higher levels of sexual violence—whether verbal, physical, or cyber sexual violence—is associated with an increase in internalizing problems.

Previous studies have concluded that some of the most common consequences of experiencing sexual violence include internalizing problems such as sleep disorders, sadness, low self-esteem, poor emotional and social self-concept, low assertiveness, negative self-perception, and a tendency toward anxiety and depression [1, 2, 29, 44, 45]. Among the most severe consequences of such violence are phobias, fears, self-harming behaviors, and even suicidal ideation [45, 46].

Regarding the previously mentioned typology of sexual violence, this study reveals interesting findings concerning experiences of cyber sexual violence. Students who have gone through this experience are more likely to exhibit moderate to high levels of internalizing problems. Estimates indicate that the likelihood of having a high level of internalizing problems is nearly twice as high for students who are victims of cyber sexual violence compared to other types of violence.

A recent study by Fundación Mutua Madrileña [47] on sexual violence against children and adolescents online highlights the psychological impact of this type of violence, characterized by suffering, silence, and loneliness. The study notes that only 1 out of 4 minors discloses their experiences to their parents. It is essential to consider that family can act as either a risk or protective factor for mental health issues [20, 26]. The psychological and emotional impact on children can be particularly devastating, as secrecy and shame often force them to face sexual violence alone. Additionally, a study by Fundación ANAR [48] on cyber sexual violence against minors found that 57.1% of victims reported abrupt changes in behavior and mood.

Continuing with this study’s findings, notable data emerge among students with a high level of externalizing problems. These students obtained higher mean scores than those in the medium- and low-level groups across all sexual violence subscales. Therefore, experiencing higher levels of sexual violence—whether verbal, physical, or cyber sexual violence—leads to an increase in externalizing problems.

Returning to the typology of sexual violence based on the type of violence (VSV, PSV, CySV) established in this study, findings also emerge regarding experiences of physical sexual violences (PSV). Students who have gone through this experience are more likely to exhibit moderate to high levels of externalizing problems. Analyzing the results, we find that the probability of experiencing externalizing problems is twice as high for students who are victims of physical sexual violences compared to the other two types of sexual violence. These results align with previous research, such as the recent study by Real-López et al. [30], which indicates that victims of this type of sexual violence may, in addition to anxiety and depression, develop certain externalizing problems, including substance abuse, eating disorders, risky sexual behaviors, and revictimization. Further supporting this, other studies on the subject agree that being a victim of physical sexual violences has a significant psychological impact, even increasing the likelihood of engaging in suicidal and non-suicidal self-harming behaviors [34–36, 49].

Limitations

We would like to point out that this research had some limitations, the most significant being the use of self-reports as the data collection method. Regarding self-reports for assessing sexual violence and mental health issues, this measure is subject to the students’ momentary and subjective perception, being relevant the factors social desirability bias, recall bias, and difficulty disclosure/silence, especially regarding sexual violence. According to Costello and Osborne [50], a factor defined by 4–5 items is considered solid and practically relevant; however, the second factor of the SVQ-VV, Victim of Physical Sexual Violences - PSV, is defined by only three items, although they are highly explicit, and the reliability indices indicated adequate internal consistency. Moreover, the CFA conducted provided evidence of a solid factorial structure.

The low Nagelkerke values obtained in the multinomial regression analyses suggest that the predictors have a relatively modest explanatory power, although the model remains statistically significant. However, the mental health variable (internalizing and externalizing problems) is highly complex and influenced by multiple personal, social, and contextual factors. Furthermore, lower values are common in behavioral science studies.

Other limitations stem from the cross-sectional design, which makes it difficult to establish stronger inferences about the relationships between the study variables. Finally, it would be ideal to replicate the study with a larger sample, representative at both the national and international scale.

Conclusions

Sexual violence against children and adolescents has become a public health issue. This research signals the relation between sexual violence and mental health in a sample from both primary and secondary students. The research sheds light onto sexual violence dynamics between minors, a topic often undetected, underestimated, and/or overshadowed.

Both sexual violence and mental health are currently two fields of concern and study in a society where, on the one hand, the rate of sexual violences on minors is increasing, and on the other, mental health problems among children and adolescents are worsening. It has been observed that different types of sexual violence, even those perceived as less harmful, relate to serious problems on the mental health of affected minors.

The findings of this research can help identify and detect risks in schools to intervene in cases of sexual violence against minors based on the type of sexual violence experienced. This study has a significant social impact as it raises awareness about the importance of addressing this issue from an early age. The results will can serve as a foundation for developing psychosocial support programs, family awareness studies and more effective and targeted public policies, ensuring an appropriate institutional response.

Finally, given the current situation surrounding this issue, the training of various profiles—such as teachers, psychologists, social workers, and healthcare staff—is crucial for detecting different types of sexual violence and providing appropriate responses to support victims’ mental health.

Authors’ contributions

Conceptualization, B.L.-d.-B., C.B.M., M.I.P.-d.-.R., J.A.D., S.M.L. and V.L.R.; methodology, B.L.-d.-B. and S.M.L.; validation, B.L.-d.-B., C.B.M., S.M.L. and V.L.R.; formal analysis, B.L.-d.-B. and S.M.L.; investigation, C.B.M. and M.I.P.-d.-.R; resources, J.A.D. and V.L.R; data curation, B.L.-d.-B.; writing—original draft preparation, C.B.M. and M.I.P.-d.-.R.; writing—review and editing, B.L.-d.-B., C.B.M., M.I.P.-d.-.R., J.A.D., S.M.L. and V.L.R.; visualization, M.I.P.-d.-.R. and J.A.D.; supervision, B.L.-d.-B., C.B.M. and V.L.R; project administration, V.L.R.; funding acquisition, M.I.P.-d.-.R. and B.L.-d.-B. All authors have read and agreed to the published version of the manuscript.

Funding

This publication has been co-financed 85% by the European Union, the Regional Development Fund and the Junta de Extremadura. Managing Authority: Ministry of Finance. File: GR24149.

Data availability

Data are contained within the article.

Declarations

Ethics approval andconsent to participate

This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the University of Extremadura (Spain), with the approval number 197/2024, dated 3 October 2024 for studies involving human subjects. Informed consent was obtained from all subjects involved in the study.

Competing interests

The authors declare no competing interests.