Health & wellbeing of sexually abused females & offspring: 25 and 27 yr. followup

描述(申请人提供)：每年有超过120万名儿童受到虐待，其中超过13.7万人是性虐待的受害者。性虐待与其他逆境不同，因为它往往在发育早期就开始，持续时间很长，与潜伏的身体边界侵犯有关，被高度污名化，可能会令人羞愧和士气低落，并对性发展产生严重影响。虽然大量文献表明儿童期性虐待对社会和心理发展有有害影响，但越来越多的证据表明，它也可能改变推定的机制，这些机制会增加成年后出现不良生理健康后果的风险。事实上，儿童期性虐待与癌症、心血管疾病、糖尿病和艾滋病毒(所有这些都是导致成年女性死亡的十大主要原因)的风险增加有关。然而，到目前为止，证据一直是相互关联的，并受到方法学缺陷的限制，如回溯性评估、横断面设计和对混淆的不充分控制。性虐待也会影响父母给子女带来风险的过程。据估计，30%有虐待史的母亲 继续虐待他们的后代或重建虐待代代相传的环境。恢复力很少是关注的焦点，对于在整个生命过程中保持相对健康的性虐待受害者的知识也很少。揭示连续性和变化的机制可以引发对现有治疗和意外干预目标的新方法。作用于生物过程的心理社会因素的发现极其重要，然而，同一项研究很少包括这些人类功能的多个层面。女性成长与发展研究(FGDS)始于1987年，保留了96%有确凿证据的性虐待和匹配比较的女性样本，是解决这些关键差距的唯一准备。在跨越6个时间点(T1-T6)的加速纵向交叉顺序设计中，多水平的生物心理社会评估在儿童/青春期早期重复三次，在青春期晚期重复两次，在成年早期重复一次。超过90%的后代在T6进行了评估。由于其独特的方法严谨性，发表在发育、心理和医学期刊上的结果为性虐待的影响提供了一些最确凿的证据。另外两项评估，T7和T8，将检验性虐待对成年期独有的不良健康后果的长期影响。在T7和T8，大多数后代将在母亲接受评估的年龄，允许通过相同的仪器和观察技术检查代际连续性。T7和T8将使用创新技术、新兴的理论范式和新的数据分析技术，以显著促进关于早期生活压力影响的科学知识。这样做将会(1) 支持因果推断，并提供必要的牵引力，将政策导向早期和持续的干预，以及(2)阐明针对一组复杂的生物、心理和社会风险的基于经验的治疗模式。

DESCRIPTION (provided by applicant): Over 1.2 million children are maltreated each year, of who over 137,000 are victims of sexual abuse. Sexual abuse is distinct from other adversities because it often starts early in development, spans long durations, is associated with insidious bodily boundary violations, is highly stigmatized, can be shaming and demoralizing, and has serious implications for sexual development. While a substantial literature suggests that childhood sexual abuse has deleterious effects on social and psychological development, there is emerging evidence that it may also alter putative mechanisms that promote risk for adverse physiological health outcomes in adulthood. Indeed, childhood sexual abuse is associated with increased risk of cancer, cardiovascular disease, diabetes, and HIV (all among the top ten leading causes of death for women in adulthood). However, evidence has thus far been correlation and limited by methodological drawbacks such as retrospective assessments, cross-sectional designs and inadequate control of confounds. Sexual abuse also affects processes in parents that confer risks to offspring. It is estimated that 30% of mothers with histories of abuse go on to abuse their offspring or recreate environments where abuse persists across generations. Resiliency is rarely a focus and knowledge about sexual abuse victims who remain relatively healthy over the life course is scant. Uncovering mechanisms for continuity and change can spark novel approaches to existing treatments and unanticipated targets for intervention. Psychosocial agents that act on biological processes are exceedingly important to uncover, yet these multiple levels of human functioning are rarely included within the same study. The Female Growth and Development Study (FGDS), which began in 1987 and has retained 96% of a sample of females with substantiated sexual abuse and matched comparisons, is uniquely poised to address these critical gaps. In an accelerated longitudinal, cross-sequential design spanning 6 time points (T1-T6), a multi-level, biopsychosocial assessment was repeated three times in childhood/early adolescence, twice in late adolescence and once in early adulthood. Over 90% of offspring were assessed at T6. Due to its distinctive methodological rigor, results published in developmental, psychological and medical journals have provided some of the most definitive evidence for the effects of sexual abuse. Two additional assessments, T7 & T8, will examine the long-term effects of sexual abuse on adverse health outcomes that are unique to the adulthood period. At T7 & T8, the majority of offspring will be at ages when their mothers were assessed, allowing an examination of intergenerational continuity through identical instrumentation and observation techniques. T7 & T8 will employ innovative technologies, emerging theoretical paradigms and novel data analytic techniques to significantly advance scientific knowledge about the impact of early life stress. Doing so will (1) bolster causal inference and provide the necessary traction to orient policy toward early and sustained intervention, and (2) illuminate empirically based treatment modalities targeting a complex set of biopsychosocial risks.