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Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2005 Mar;82(Suppl 1):i89–i99. doi: 10.1093/jurban/jti028

Men’s pathways to risky sexual behavior: Role of co-occurring childhood sexual abuse, posttraumatic stress disorder, and depression histories

William C Holmes 1,✉, Edna B Foa 2, Mary D Sammel 3
PMCID: PMC3456164  PMID: 15738316

Abstract

Recent reports of sexually transmitted infection-rate increases among men indicate the need for renewed study of male sexual risk behavior to aid development of updated and novel risk reduction interventions. Men who have childhood sexual abuse (CSA) histories consistently report frequent sexual risk behavior. The objective of this sturdy is to explore whether posttraumatic stress disorder (PTSD) and depression are moderators and/or mediators of the association between CSA and sexual risk in adult men. A cross-sectional survey study employing random digit dial recruitment was administered to men aged 18–49 years from Philadelphia County. Two bundred ninety eight men were recruited and screened for CSA history, administered items from the Posttraumatic Stress Diagnostic Scale (PDS) and Center for Epidemiologic Studies—Depression (CES-D), and asked to estimate their number of lifetime sexual partners (LSPs). Effects of sociodemographic characteristics, CSA, PTSD, and depression on the number of LSPs were modeled using Poisson regression. Results show that 197 (66%) men participated; 43 (22%) had CSA histories. CSA was significantly associated with PTSD/depression (P=.03). Four sociodemographic variables (age, race, sexual identity, and education), CSA (incidence rate ratio, IRR=1.47, P<.001), PTSD (IRR=1.19, P=.04), depression (IRR=1.29, P=.001), all 2-way interactions, and the 3-way CSA/PTSD/depression interaction (IRR=11.00, P<.001) were associated with the number of LSPs (R2=0.27). In conclusion, sexual partnership patterns unique to men with CSA histories and comorbid PTSD/depression appear to lead to substantially higher numbers of LSPs. Estimates of this relationship may have been biased toward the null by underreporting that can occur with phone surveys. Cross-sectional studies do not support causal inferences; however, the identification of a moderating and mediating influence of PTSD/depression on the relationship between CSA and sexual risk behavior is important and suggests the need for future studies with larger samples that examine trajectories for CSA, psychiatric illness, and sexual partnerships.

Keywords: Depression, Men, Posttraumatic stress disorder, Sexual abuse, Sexual behavior

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References

  • 1.Bartholow BN, Doll LS, Joy D, et al. Emotional, behavioral, and HIV risks associated with sexual abuse among adult homosexual and bisexual men. Child Abuse Negl. 1994;18:747–761. doi: 10.1016/0145-2134(94)00042-5. [DOI] [PubMed] [Google Scholar]
  • 2.Burgess AW, Hartman CR, McCormack A. Abused to abuser: antecedents of socially deviant behaviors. Am J Psychiatry. 1987;144:1431–1436. doi: 10.1176/ajp.144.11.1431. [DOI] [PubMed] [Google Scholar]
  • 3.Carballo-Dieguez A, Dolezal C. Association between history of childhood sexual abuse and adult HIV-risk sexual behavior in Puerto Rican men who have sex with men. Child Abuse Negl. 1995;19:595–605. doi: 10.1016/0145-2134(95)00018-4. [DOI] [PubMed] [Google Scholar]
  • 4.Futterman D, Hein K, Reuben N, Dell R, Shaffer N. Human immunodeficiency virus-infected adolescents: the first 50 patients in a New York City program. Pediatrics. 1993;91:730–735. [PubMed] [Google Scholar]
  • 5.Lenderking WR, Wold C, Mayer KH, Goldstein R, Losina E, Seage GR. Childhood sexual abuse among homosexual men. Prevalence and association with unsafe sex. J Gen Intern Med. 1997;12:250–253. doi: 10.1046/j.1525-1497.1997.012004250.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Nagy S, Adcock AG, Nagy MC. A comparison of risky health behaviors of sexually active, sexually abused, and abstaining adolescents. Pediatrics. 1994;93:570–575. [PubMed] [Google Scholar]
  • 7.Nelson DE, Higginson GK, Grant-Worley JA. Using the youth risk behavior survey to estimate prevalence of sexual abuse among Oregon high school students. J Sch Health. 1994;64:413–416. doi: 10.1111/j.1746-1561.1994.tb03264.x. [DOI] [PubMed] [Google Scholar]
  • 8.O’Leary A, Purcell D, Remien RH, Gomez C. Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men. AIDS Care. 2003;15:17–26. doi: 10.1080/0954012021000039725. [DOI] [PubMed] [Google Scholar]
  • 9.Paul JP, Catania J, Pollack L, Stall R. Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men. The Urban Men’s Health Study. Child Abuse Negl. 2001;25:557–584. doi: 10.1016/S0145-2134(01)00226-5. [DOI] [PubMed] [Google Scholar]
  • 10.Resnick MD, Blum RW. The association of consensual sexual intercourse during childhood with adolescent health risk and behaviors. Pediatrics. 1994;94:907–913. [PubMed] [Google Scholar]
  • 11.Weber FT, Gearing J, Davis A, Conlon M. Prepubertal initiation of sexual experiences and older first partner predict promiscuous sexual behavior of delinquent adolescent males-unrecognized child abuse. J Adolesc Health. 1992;13:600–605. doi: 10.1016/1054-139X(92)90374-K. [DOI] [PubMed] [Google Scholar]
  • 12.Zierler S, Feingold L, Laufer D, Velentgas P, Kantrowitz-Gordon I, Mayer K. Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. Am J Public Health. 1991;81:572–575. doi: 10.2105/AJPH.81.5.572. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Miller M. A model to explain the relationship between sexual abuse and HIV risk among women. AIDS Care. 1999;11:3–20. doi: 10.1080/09540129948162. [DOI] [PubMed] [Google Scholar]
  • 14.Stiffman AR, Dore P, Earls F, Cunningham R. The influence of mental health problems on AIDS-related risk behaviors in young adults. J Nerv Ment Dis. 1992;180:314–320. doi: 10.1097/00005053-199205000-00005. [DOI] [PubMed] [Google Scholar]
  • 15.Briere J, Evans D, Runtz M, Wall T. Symptomatology in men who were molested as children: a comparison study. Am J Orthopsychiatry. 1988;58:457–461. doi: 10.1111/j.1939-0025.1988.tb01606.x. [DOI] [PubMed] [Google Scholar]
  • 16.Boney-McCoy S, Finkelhor D. Psychosocial sequelae of violent victimization in a national youth sample. J Consult Clin Psychol. 1995;63:726–736. doi: 10.1037/0022-006X.63.5.726. [DOI] [PubMed] [Google Scholar]
  • 17.Hunter JA. A comparison of the psychosocial maladjustment of adult males and females sexually molested as children. J Interpers Violence. 1991;6:205–217. [Google Scholar]
  • 18.Hussey DL, Strom G, Singer M. Male victims of sexual abuse: an analysis of adolescent psychiatric inpatients. Child Adolesc Soc Work. 1992;9:491–503. doi: 10.1007/BF00845410. [DOI] [Google Scholar]
  • 19.Langevin R, Wright P, Handy L. Characteristics of sex offenders who were sexually victimized as children. Ann Sex Res. 1989;2:227–253. doi: 10.1007/BF00849717. [DOI] [Google Scholar]
  • 20.Robin RW, Chester B, Rasmussen JK, Jaranson JM, Goldman D. Prevalence, characteristics, and impact of childhood sexual abuse in a Southwestern American Indian tribe. Child Abuse Negl. 1997;21:769–787. doi: 10.1016/S0145-2134(97)00038-0. [DOI] [PubMed] [Google Scholar]
  • 21.Roesler TA, McKenzie N. Effects of childhood trauma on psychological functioning in adults sexually abused as children. J Nerv Ment Dis. 1994;182:145–150. doi: 10.1097/00005053-199403000-00003. [DOI] [PubMed] [Google Scholar]
  • 22.Schulte JG, Dinwiddie SH, Pribor EF, Yutzy SH. Psychiatric diagnoses of adult male victims of childhood sexual abuse. J Nerv Ment Dis. 1995;183:111–113. doi: 10.1097/00005053-199502000-00010. [DOI] [PubMed] [Google Scholar]
  • 23.Windle M, Windle RC, Scheidt DM, Miller GB. Physical and sexual abuse and associated mental disorders among alcoholic inpatients. Am J Psychiatry. 1995;152:1322–1328. doi: 10.1176/ajp.152.9.1322. [DOI] [PubMed] [Google Scholar]
  • 24.Wolfe DA, Sas L, Wekerle C. Factors associated with the development of posttraumatic stress disorder among child victims of sexual abuse. Child Abuse Negl. 1994;18:37–50. doi: 10.1016/0145-2134(94)90094-9. [DOI] [PubMed] [Google Scholar]
  • 25.Hirschfeld RMA. The comorbidity of major depression and anxiety disorders: recognition and management in primary care. Primary Care Companion. J Clin Psychiatry. 2001;3:244–252. doi: 10.4088/pcc.v03n0609. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.AIDS Surveillance Quarterly Update (Cases Reported through March 31, 2000) Philadelphia, PA: AIDS Activities Coordinating Office, Epidemiology Unit; 2000. pp. 16–16. [Google Scholar]
  • 27.Laumann EO, Gagnon JH, Michael RT, Michaels S. Sexually transmitted infections. Chicago, IL: University of Chicago Press; 1994. pp. 376–441. [Google Scholar]
  • 28.Laumann EO, Gagnon JH, Michael RT, Michaels S. The number of partners. Chicago, IL: University of Chicago Press; 1994. pp. 172–224. [Google Scholar]
  • 29.Finkelhor D, Hotaling G, Lewis IA, Smith C. Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors. Child Abuse Negl. 1990;14:19–28. doi: 10.1016/0145-2134(90)90077-7. [DOI] [PubMed] [Google Scholar]
  • 30.Tanner JM, Davies PS. Clinical longitudinal standards for height and height velocity for North American children. J Pediatr. 1985;107:317–329. doi: 10.1016/S0022-3476(85)80501-1. [DOI] [PubMed] [Google Scholar]
  • 31.Needleman RD. Adolescence. In: Nelson WE, editor. Textbook of Pediatrics. Philadelphia, PA: W.B. Saunders; 1996. pp. 58–63. [Google Scholar]
  • 32.Foa EB, Riggs DS, Dancu CV, Rothbaum BO. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress. 1993;6:459–473. doi: 10.1007/BF00974317. [DOI] [Google Scholar]
  • 33.Roberts RE. Reliability of the CES-D Scale in different ethnic contexts. Psychiatry Res. 1980;2:125–134. doi: 10.1016/0165-1781(80)90069-4. [DOI] [PubMed] [Google Scholar]
  • 34.Stallones L, Marx MB, Garrity TF. Prevalence and correlates of depressive symptoms among older U.S. adults. Am J Prev Med. 1990;6:295–303. [PubMed] [Google Scholar]
  • 35.Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401. [Google Scholar]
  • 36.Gartner RB. Betrayed as Boys. Psychodynamic Treatment of Sexually Abused Men. New York, NY: Guilford Press; 1999. pp. 356–356. [Google Scholar]
  • 37.Runyon MK, Faust J, Orvaschel H. Differential symptom pattern of post-traumatic stress disorder (PTSD) in maltreated children with and without concurrent depression. Child Abuse Negl. 2002;26:39–53. doi: 10.1016/S0145-2134(01)00305-2. [DOI] [PubMed] [Google Scholar]
  • 38.Liljeros F, Edling CR, Nunes Amaral LA. Sexual networks. Implications for the transmission of sexually transmitted infections. Microbes Infect. 2003;5:189–196. doi: 10.1016/S1286-4579(02)00058-8. [DOI] [PubMed] [Google Scholar]
  • 39.Mulrow CD, Williams JW, Gerety MB, Ramirez G, Montiel OM, Kerber C. Case-finding instruments for depression in primary care settings. Ann Intern Med. 1995;122:913–921. doi: 10.7326/0003-4819-122-12-199506150-00004. [DOI] [PubMed] [Google Scholar]
  • 40.Foa EB, Tolin DF. Comparison of the PTSD Symptom Scale-Interview Version and the Clinician-Administered PTSD scale. J Trauma Stress. 2000;13:181–191. doi: 10.1023/A:1007781909213. [DOI] [PubMed] [Google Scholar]
  • 41.Kessler RC. Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry. 2000;61:4–14. [PubMed] [Google Scholar]
  • 42.Engdahl BE, Speed N, Eberly RE, Schwartz J. Comorbidity of psychiatric disorders and personality profiles of American World War II prisoners of war. J Nerv Ment Dis. 1991;179:181–187. doi: 10.1097/00005053-199104000-00001. [DOI] [PubMed] [Google Scholar]
  • 43.Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:1048–1060. doi: 10.1001/archpsyc.1995.03950240066012. [DOI] [PubMed] [Google Scholar]
  • 44.Breslau N, Davis GC, Andreski P, Peterson E. Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry. 1991;48:216–222. doi: 10.1001/archpsyc.1991.01810270028003. [DOI] [PubMed] [Google Scholar]
  • 45.Breslau N, Davis GC, Peterson E, Schultz L. Psychiatric sequelae of posttraumatic stress disorder in women. Arch Gen Psychiatry. 1997;54:81–87. doi: 10.1001/archpsyc.1997.01830130087016. [DOI] [PubMed] [Google Scholar]
  • 46.Marshall RD, Olfson M, Hellman F, Blanco C, Guardino M, Struening EL. Comorbidity, impairment, and suicidality in subthreshold PTSD. Am J Psychiatry. 2001;158:1467–1473. doi: 10.1176/appi.ajp.158.9.1467. [DOI] [PubMed] [Google Scholar]

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