Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2014 Jun 1.
Published in final edited form as: Child Abuse Negl. 2013 Mar 14;37(6):400–403. doi: 10.1016/j.chiabu.2013.01.007

High-Risk Sexual Behaviors among Depressed Black Women with Histories of Intrafamilial and Extrafamilial Childhood Sexual Abuse

Katherine N Lestrade 1, Nancy L Talbot 1, Erin A Ward 1, Natalie A Cort 1
PMCID: PMC3672327  NIHMSID: NIHMS443004  PMID: 23499057

Abstract

Objective

National estimates of childhood sexual abuse histories among black women range from 34% to 40%. Poor outcomes in adulthood, including impaired psychiatric functioning (e.g., depression), high-risk sexual behaviors (e.g., unprotected sex, exchange of sex for money or drugs), and lifetime sexually transmitted infections are robustly associated with sexual abuse histories. In the current study, we examined the relationships of intrafamilial and extrafamilial perpetration of childhood sexual abuse to high-risk sexual behaviors and sexually transmitted infections among black women.

Methods

We conducted a secondary analysis of data from 60 black women who participated in a depression treatment trial in a community mental health center.

Results

Our results demonstrated that intrafamilial perpetration of childhood sexual abuse, as compared to extrafamilial perpetration, was more strongly associated with high-risk sexual behaviors in a clinical sample of depressed black women. There were no significant associations between intrafamilial or extrafamilial perpetration of childhood sexual abuse and sexually transmitted infections.

Conclusions

These findings suggest that characteristics of childhood sexual abuse among depressed black women may be important factors for health professionals to consider when conducting clinical assessments and providing treatment.

Keywords: Black Women, Childhood Sexual Abuse, Depression, Sexual Behaviors

Introduction

In the United States, estimates of childhood sexual abuse (CSA) histories among black women range from 34% to 40% (Amodeo, Griffin, Fassler, Clay, & Ellis, 2006; Boynton-Jarrett, Rosenberg, Palmer, Boggs, & Wise, 2012). Sexual abuse is a robust predictor of poor psychiatric functioning (e.g., depression) (Molnar, Buka, & Kessler, 2001), high-risk sexual behaviors (e.g., unprotected sex, greater number of sexual partners, exchange of sex for money or drugs) (Arriola, Louden, Doldren, & Fortenberry, 2005; Senn & Carey, 2010), HIV infection (Wyatt et al., 2002), and other sexually transmitted infections (STIs) (Wingood & DiClemente, 1997). Research examining links between CSA characteristics, high-risk sexual behaviors, and STIs among black women is limited. The current study examined the hypothesis that intrafamilial perpetration of black women’s first CSA experience, compared to extrafamilial perpetration, is associated with more high-risk sexual behaviors and STIs.

Method

The current study is a secondary analysis of data from an ongoing depression treatment trial in a community mental health center. For these analyses, we examined data for black female participants only (n = 60). All participants were age 18 and older, had diagnoses of current major depression established through the Structured Clinical Interview for Axis I DSM-IV Disorders (Spitzer, Gibbon, & Williams, 1994), and reported CSA histories. Childhood sexual abuse was assessed with a structured clinical interview and defined as: prior to age 18, any unwanted sexual contact or any sexual contact with a family member five or more years older (Talbot et al., 2005; Talbot et al., 2011). Sexual contact was defined as physical contact of a sexual nature, ranging from fondling to sexual intercourse. The University of Rochester’s Institutional Review Board approved the study protocol.

Measures

A self-report survey of sexual experiences, which included items drawn from the Trauma Symptom Inventory (Briere, Elliot, Harris, & Cotman, 1995) and the revised Conflict Tactics Scale (Straus, Hamby, Boney-McCoy, & Sugarman, 1996), assessed the frequency (never = 0, rarely = 1, sometimes = 2, often = 3) of high-risk sexual behaviors (i.e., sex with strangers, exchange of sex for money or drugs, emotionally coerced sex, sex in response to physical threats, physically forced sex) within the previous 6 months. Frequency ratings for each item were summed and divided by 5 to obtain a score that reflected the average frequency of these behaviors. Higher scores represent higher engagement in high-risk sexual behaviors. A self-report health history questionnaire, designed for the controlled trial, assessed lifetime presence or absence of STIs (e.g., herpes, human papillomavirus, chlamydia). The Characteristics of Childhood Sexual Abuse Interview (Talbot et al., 1999) were used to gather dichotomously coded data (present vs. absent) on intrafamilial and extrafamilial CSA perpetration, as well as age of first CSA experiences.

Data analytical approach

The independent variable was type of perpetrator (intrafamilial vs. extrafamilial) of patients’ first-reported CSA experience. The two dependent variables were: adult high-risk sexual behaviors, and lifetime STIs. To evaluate relationships between the independent and two dependent variables, a t-test and chi-square test were conducted, respectively. For both analyses, p<.05 was considered significant.

Results

Women in the study had a mean age of 35.2 years (SD = 11.1). Many women were living without spouses/partners (n = 29, 48.3%), and most (n = 38, 63.3%) had children living at home. A significant portion (n = 28, 46.7%) were unemployed and had incomes that were less than $10,000 per year (n = 36, 60%). The majority of women (n = 42, 70%) reported more than one major depressive episode and upon entry to the trial 27 (45%) were diagnosed with major depressive disorder, recurrent, severe without psychotic features. Current posttraumatic stress disorder was diagnosed in the majority (n = 49, 81.7%) of women. Most women (n = 44, 73.3%) reported that their first CSA experiences were perpetrated by family members and that their mean age at the time of the abuse was 8.1 years (SD = 3.9). Moreover, more than half (n = 37, 61.7%) indicated that their first sexual abuse experience involved penetration/intercourse.

Overall, 30 (50%) women reported being infected with at least one STI during their lifetimes. Of these women, seven (11.7%) reported diagnoses of HIV/AIDS. In addition, examinations of high-risk sexual behaviors demonstrated that 11 (18.3%) women reported they had sex with strangers, 15 (25%) had exchanged sex for money or drugs, and 17 (28.3%) had been emotionally coerced to engage in sexual intercourse within the prior 6 months. Women who reported intrafamilial perpetration of CSA had more high-risk sexual behaviors within the previous 6 months (M = 2.23, SD = 2.92) than women with extrafamilial CSA histories (M = .80, SD = .94), t(57) = 2.84, p = .006. However, the association between the type of CSA perpetrator (intrafamilial vs. extrafamilial) and STI histories, χ2(59) = 3.12, p = .20, was not significant.

Discussion

Black women’s sexual health is of significant public health importance, in part due to their disproportionate risk of contracting HIV as compared to white women (Centers for Disease Control and Prevention, 2008). In this study, we examined associations between intrafamilial perpetration of black women’s first reported CSA experience, high-risk sexual behaviors, and lifetime STIs. We explored these associations in a sample of clinically depressed black women. Previous research has shown that depression is a risk factor for high-risk sexual behaviors (Hutton, Lyketos, Zenilman, Thompson, & Erbelding, 2004; Khan et al., 2009). We found that black women who reported intrafamilial perpetration of CSA had engaged in more high-risk sexual behaviors (e.g., sex with strangers, exchange of sex for money or drugs) than women with extrafamilial perpetration histories. However, our results did not demonstrate stronger associations between intrafamilial CSA perpetration, compared to extrafamilial perpetration, and STIs.

Attachment theory provides a conceptual framework for understanding the association between intrafamilial abuse perpetration and sexual functioning (Bowlby, 1988). The theory suggests that when threatened or distressed, children seek protection and care from their parents or caregivers. Parents’ availability and responsiveness shape children’s perception of their importance and worth. When attachment figures are responsible for perpetrating abuse, competing desires to flee from and seek proximity to these figures compromises children’s abilities to fully organize and competently respond to harmful or risky situations (Main & Solomon, 1990). Bowlby (1988) also theorized that children develop enduring internal working models, i.e., representations of the self, others, and relationships. These models are shaped by the nature of early attachment experiences (Ainsworth, Blehar, Waters, & Wall, 1978; Main & Solomon, 1990) and influence adult relationship functioning. Extrapolating from this theory, intrafamilial CSA perpetration may result in working models that evoke passive acquiescence to risky sexual demands and limited sexual/intimacy boundaries (e.g., promiscuity).

In the current study, 50% of our sample of depressed black women reported lifetime STIs. Similar rates have been recorded in other samples of black women (e.g., Cavanaugh et al., 2011). Although previous studies indicate a strong link between reports of CSA and STIs, we found no association. However, we examined a specific characteristic of CSA, perpetrator type, and can only speculate about the null findings. Other studies have identified a variety of non-behavioral factors (e.g., mental health disorders, marital status, socioeconomic status) that mediate the association between CSA and STI risk (Berg et al., 2012; Sweet, Polansky, & Welles, 2012; Wyatt et al., 2002). Possible intervening variables in the relationship between type of CSA perpetrator and STIs were not examined in this study.

Limitations

Our results from a sample of depressed, black women may not be generalizable to women of other races, nonclinical populations, or clinical populations with different socio-demographic characteristics. We did not assess developmental and psychosocial factors, such as family functioning (Fassler et al., 2005) that may contribute to intrafamilial CSA risk or adult sexual behavior. The validity of retrospective reporting of childhood abuse experiences has been questioned. However, research suggests that retrospective reports of childhood abuse by adults have long-term reliability and evidence of familial corroboration (Amodeo, & Griffin, 2009; Nelson, Lynskey, Heath, Madden, & Martin, 2010). We did not administer a comprehensive assessment of STIs and sexual risk behaviors (e.g., condom use). A more detailed approach may have gained more endorsements.

Implications

We found that the average age at first CSA occurrence was 8 years, and that it typically involved sexual intercourse. Given the early age of exposure to sexual trauma, it is incumbent upon parents, school personnel, and social services to be educated about school-aged black girls’ vulnerability to sexual abuse and behavioral indicators of abuse. Primary prevention programs to educate children and families about abuse risk, as well as early intervention programs, for abused children are critical. For health professionals treating depressed black women with childhood sexual abuse histories, the clinical assessment of high-risk sexual behaviors and subsequent intervention may be informed by an understanding of the nature of the sexual abuse. In particular, women abused by a family member may be at particularly high risk for dangerous sexual experiences that could have damaging consequences.

Acknowledgments

This research was supported by National Institute of Mental Health grants K23 MH064528 and R01 MH07692803S1.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

References

  1. Ainsworth M. Attachments beyond infancy. American Psychologist. 1989;44:709–716. doi: 10.1037//0003-066x.44.4.709. [DOI] [PubMed] [Google Scholar]
  2. Ainsworth MD, Blehar MC, Waters E, Wall S. Patterns of Attachment: Assessed in the Strange Situation and at Home. Hillsdale, N.J.: Lawrence Erlbaum; 1978. [Google Scholar]
  3. Amodeo M, Griffin ML. Sibling agreement on retrospective reports of parental alcoholism and other childhood events. Substance Use & Misuse. 2009;44:943–964. doi: 10.1080/10826080802490709. [DOI] [PubMed] [Google Scholar]
  4. Amodeo M, Griffin ML, Fassler IR, Clay CM, Ellis MA. Childhood sexual abuse among black women and white women from two-parent families. Child Maltreatment. 2006;11:237–246. doi: 10.1177/1077559506289186. [DOI] [PubMed] [Google Scholar]
  5. Arriola KRJ, Louden T, Doldren MA, Fortenberry RM. A meta-analysis of the relationship of child sexual abuse to HIV risk behavior among women. Child Abuse & Neglect. 2005;29:725–746. doi: 10.1016/j.chiabu.2004.10.014. [DOI] [PubMed] [Google Scholar]
  6. Berg CJ, Painter JE, Sales JM, Mays D, Rose E, Wingood GM, Diclemente RJ. Smoking as a risk factor for STI diagnosis among African American females. American Journal of Health Behavior. 2012;36(4):505–512. doi: 10.5993/AJHB.36.4.7. [DOI] [PubMed] [Google Scholar]
  7. Bowlby J. A Secure Base: Parent-Child Attachment and Healthy Human Development. London, UK: Routledge; 1988. [Google Scholar]
  8. Boynton-Jarrett R, Rosenberg L, Palmer JR, Boggs DA, Wise LA. Child and adolescent abuse in relation to obesity in adulthood: The Black Women's Health Study. Pediatrics. 2012;130(2):1–9. doi: 10.1542/peds.2011-1554. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Briere J, Elliott DM, Harris K, Cotman A. Trauma Symptom Inventory: Psychometrics and association with childhood and adult trauma in clinical samples. Journal of Interpersonal Violence. 1995;10:387–401. [Google Scholar]
  10. Cavanaugh CE, Floyd LJ, Penniman TV, Hulbert A, Gaydos C, Latimer WW. Examining racial/ethnic disparities in sexually transmitted diseases among recent heroin-using and cocaine-using women. Journal of Women's Health. 2011;20(2):197–205. doi: 10.1089/jwh.2010.2140. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Centers for Disease Control and Prevention. Subpopulation estimates from the HIV Incidence Surveillance System—United States, 2006. MMWR. 2008;57(36):985–989. [PubMed] [Google Scholar]
  12. Fassler IR, Amodeo M, Griffin ML, Clay CM, Ellis MA. Predicting long-term outcomes for women sexually abused in childhood: Contribution of abuse severity versus family environment. Child Abuse & Neglect. 2005;29(3):269–284. doi: 10.1016/j.chiabu.2004.12.006. [DOI] [PubMed] [Google Scholar]
  13. Finkelhor D, Browne A. The traumatic impact of child sexual abuse: A conceptualization. American Journal of Orthopsychiatry. 1985;55:530–541. doi: 10.1111/j.1939-0025.1985.tb02703.x. [DOI] [PubMed] [Google Scholar]
  14. Hutton HE, Lyketsos CG, Zenilman JM, Thompson RE, Erbelding EJ. Depression and HIV risk behaviors among patients in a sexually transmitted disease clinic. American Journal of Psychiatry. 2004;161:912–914. doi: 10.1176/appi.ajp.161.5.912. [DOI] [PubMed] [Google Scholar]
  15. Khan MR, Kaufman JS, Pence BW, Gaynes BN, Adimora AA, Weir SS, Miller WC. Depression, sexually transmitted infection, and sexual risk behavior among young adults in the United States. Archives of Pediatrics & Adolescent Medicine. 2009;163(7):644–652. doi: 10.1001/archpediatrics.2009.95. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Main M, Solomon J. Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. In: Greenberg MT, Cicchetti D, Cummings EM, editors. Attachment during the preschool years: Theory, research and intervention. Chicago: University of Chicago Press; 1990. [Google Scholar]
  17. Molnar BE, Buka SL, Kessler RC. Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American Journal of Public Health. 2001;91(5):753–760. doi: 10.2105/ajph.91.5.753. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Nelson EC, Lynskey MT, Heath AC, Madden PAF, Martin NG. A family study of adult twins with and without a history of childhood abuse: Stability of retrospective reports of maltreatment and associated family measures. Twin Research and Human Genetics. 2010;13:121–130. doi: 10.1375/twin.13.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Senn TE, Carey MP. Child maltreatment and women's adult sexual risk behavior: Childhood sexual abuse as a unique risk factor. Child Maltreatment. 2010;15(4):324–335. doi: 10.1177/1077559510381112. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Slonim-Nevo V, Mukuka L. Child abuse and AIDS-related knowledge, attitudes and behaviour among adolescents in Zambia. Child Abuse & Neglect. 2007;31:143–159. doi: 10.1016/j.chiabu.2006.08.006. [DOI] [PubMed] [Google Scholar]
  21. Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for Axis I DSM-IV Disorder. New York: Biometrics Research, New York State Psychiatric Institute; 1994. [Google Scholar]
  22. Steel J, Herlitz C. The association between childhood and adolescent sexual abuse and proxies for sexual risk behavior: A random sample of the general population of Sweden. Child Abuse & Neglect. 2005;29(10):1141–1153. doi: 10.1016/j.chiabu.2004.10.015. [DOI] [PubMed] [Google Scholar]
  23. Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB. The revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues. 1996;17:283–316. [Google Scholar]
  24. Sweet T, Polansky M, Welles SL. Mediation of HIV/STI risk by mental health disorders among persons living in the US reporting childhood sexual abuse, [published online ahead of print September 26, 2012] Journal of Acquired Immune Deficiency Syndromes. 2012 doi: 10.1097/QAI.0b013e318273b0c7. [DOI] [PubMed] [Google Scholar]
  25. Talbot NL, Chaudron LH, Ward EA, Duberstein PR, Conwell Y, O’Hara MW, Tu X, Lu N, He H, Stuart S. A randomized effectiveness trial of interpersonal psychotherapy for depressed women with sexual abuse histories. Psychiatric Services. 2011;62:374–380. doi: 10.1176/appi.ps.62.4.374. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Talbot NL, Conwell Y, O’Hara MW, Stuart S, Ward EA, Gamble SA, Watts A, Tu X. Interpersonal psychotherapy for depressed women with sexual abuse histories: A pilot study in a community mental health center. Journal of Nervous and Mental Disorders. 2005;193:847–850. doi: 10.1097/01.nmd.0000188987.07734.22. [DOI] [PubMed] [Google Scholar]
  27. Talbot NL, Houghtalen R, Duberstein PR, Cox C, Giles DE, Wynne LC. Effects of group treatment for women reporting histories of childhood sexual abuse. Psychiatric Services. 1999;50:686–692. doi: 10.1176/ps.50.5.686. [DOI] [PubMed] [Google Scholar]
  28. Wingood GM, DiClemente RJ. Child sexual abuse, HIV sexual risk, and gender relations of African-American women. American Journal of Preventive Medicine. 1997;13:380–384. [PubMed] [Google Scholar]
  29. Wyatt GE, Myers HF, Williams JK, Kitchen CR, Loeb T, Carmona JV, Wyatt L, Chin D, Presley N. Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy. American Journal of Public Health. 2002;92:660–665. doi: 10.2105/ajph.92.4.660. [DOI] [PMC free article] [PubMed] [Google Scholar]

RESOURCES