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An Integrative Review
Kimberli I. Johnson
I PledgeKIJ
AN INTEGRATIVE REVIEW 2
Abstract
The purpose of this integrative review is to analyze the literature regarding the effects of
childhood abuse and the influence it has on mental illness in adulthood. Childhood abuse is
rarely reported, but when it is, there is an opportunity to get treatment for that individual.
Sometimes that is not the case, which could lead to mental illness in adulthood. The database that
was used was CINAHL (Cumulative Index of Nursing and Allied Health Literature) Complete,
within the EBSCO database search engine. The search yielded 556 articles, five of which met the
criteria. The five articles provide insight on the relationship between childhood abuse and the
onset of a mental illness in adulthood. The five articles all depicted many factors that needed to
be considered when exploring this topic, but all could satisfy the association between child abuse
and mental illness in adulthood. There were several limitations including the students inability
to write an integrative review, the year of publishings were limited to the last five years, and the
personal issues the student faced while writing this integrative review. Future research should be
done in variety of locations, so that the study can be accurately portrayed, and not using just one
method of obtaining information, which majority of the studies were responsible for. All five of
An Integrative Review
The purpose of this integrative review is to search the literature regarding the effects of
childhood abuse and the influence it has on mental illness in adulthood. Children in all societies
are often neglected, maltreated, abused, intentionally or otherwise by their parents, siblings, and
in school (Saha et al., 2012). This progression causes children to grow up and predisposes them
to a mental health problem or possibly commit suicide. Reporting and treating are important
factors that could possibly help these children overcome obstacles they may face due to the
abuse. The researcher obtained several pieces of information on the relationship between
childhood abuse and the effects on mental health in adulthood, which answered the following
PICOT question: Does being physically and/or sexually abused influence the outcome of having
a mental illness in patients who have been abused as a child? The familys socioeconomic status
was a big factor when it came to getting help for children and the reason the history abuse was
carried over into adulthood. This topic interests the researcher due to the increase of child abuse
and the decrease in reporting which causes the individual to experience adulthood full of
hardships.
This integrative review focuses on five qualitative research articles. The website used to
obtain the articles was MyAthens, which is accessed through the BSMCON Library Databases.
The search engines that were utilized were EBSCO host, CINAHL complete, which has journals
related to nursing and health related publications. The terms that were searched in these
databases included abuse, childhood, adulthood, and mental illness. This search yielded
556 articles, with five only meeting the criteria and containing a wealth of pertinent information.
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To obtain current issues on this topic, the search was filtered to only articles between the
years of 2012 to 2017. Peer-reviewed articles narrowed the search. The search was conducted to
address the PICOT question at hand. The articles were narrowed down based on childhood abuse
and mental health in adulthood. The articles that were utilized in this review included five
Findings/Results
The findings and results of the five peer-reviewed articles identified an association with
child abuse and effects of mental health in adulthood (Easton et al, 2010; E. Fuller- Thomson,
2012; Horan & Widom, 2014; Saha et al, 2012; Unger & De Luca, 2014;). Table 1 provides a
summary of research. Research has found that child abuse and neglect puts individuals at risk
for a wide range of negative outcomes across the lifespan (Horan and Widom, 2014). The
researcher outline the review based on the following categories: anxiety, depression, and
sexuality.
Anxiety
Three qualitative studies indicated that anxiety was a major effect of child abuse (E.
Fuller-Thomson et al (2012); Saha et al (2012); Unger & De Luca (2014)) . A qualitative study
anxiety disorders. The study wanted to examine some inconsistencies in previous studies that
were done on this topic. This study used data from the 2005 cycle of Canadian Community
Health Survey (CCHS) conducted by Statistics Canada. This survey provides health
determinants, health status, and health system utilization. The participants in this study were only
asked about childhood abuse. Respondents who did not have complete data were removed, so it
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did not skew the findings. This study asked participants if they were diagnosed by a health
professional so that data was accurate and unbiased. Again, the findings of this study
determined there was an association between child physical abuse and anxiety disorders in
adulthood.
study found that specific interventions helped teenagers and their family cope with their past.
Like the previous study, long-term mental health consequences of abuse in childhood includes
depression and anxiety, low self-esteem, difficulty establishing and maintain relationships, eating
disorders, and suicidal attempts. Saha et al (2012), presents individual therapy is directed
towards helping the adolescent to take control over their suicidal and anxious feelings and seek
The qualitative study, conducted by Saha et al (2012), included one individual, a 15-year-
old boy who was brought to an outpatient clinic. The study was conducted by having the boy
come to the clinic weekly for the first 2 months, followed by biweekly visits by the health
coordinator. Treatment aimed at family counseling at the clinic by the physician as well as at
home visits.
The qualitative study conducted by Unger and De Luca (2014), aimed at identifying the
insecure attachment style associated with childhood physical abuse. A history of physical abuse
was associated with attachment avoidance whole controlling for other forms of childhood abuse.
A second evaluation was conducted by the authors, which found significant relationships
between history of physical abuse and an undesirable view of self or anxiety in adulthood.
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Unlike the study by Saha et al (2012), the participants in the qualitative study conducted
by Ungar and De Luca (2014), included 552 females and 294 male university students from an
Introductory Psychology class. The participants completed several questionnaires intended to tap
the variables of interest. Demographics were completed, The Experiences in Close Relationships
Scale was used to evaluate anxiety and avoidance dimensions of attachment in adulthood.
Depression
much larger sample size, including 12,481 respondents from the Canadian provinces of Manitoba
and Saskatchewan in Toronto Canada. The study found a relationship between child physical
abuse and anxiety disorders with factors of demographics, family background, current
socioeconomic status, and stressors. The individuals with the mental health issues are less likely
to seek medical care and less likely to receive a diagnosis, which leads them to a road of
depression.
While following a 15-year-old boys life, Saha et al (2012) highlighted the interactions in
children being subjected to neglect, maltreatment, and abuse, resulting in emotional health issues
in adolescence. The long-term abuse can cause impaired development with decreased cognitive,
language, and academic abilities. After continuously interviewing this patient, Saha et al (2012)
determined the consequences in adulthood as depression, anxiety, low self-esteem, and difficulty
Sexuality
Two qualitative studies found sexual trauma due to child abuse (Easton et al, 2010;
Horon and Widom, 2014). Easton et al (2010), conducted a semi-structured telephone interview
to study whether and how characteristics of childhood sexual child abuse and disclosure
influenced three dimensions if psychosexual function during adulthood. The sample included
165 adults who were sexually abused as children; all ranging from the age of 20 and older. The
purpose of the study was to understand variability in psychosocial functioning among adults who
were sexually abused as children. The study determined that two factors affected all the
dimensions of psychosocial dysfunction: age at the time of abuse and telling someone at the time
of the abuse. It was determined that sexual trauma was due to their understanding of the sexual
implications of abuse.
Horon and Widom (2014), used a study based on cohort design study. The purpose of the
study was to examine whether the ages of onset of four risk behaviors sexual intercourse,
alcohol use, drug use and criminal activity mediate relationship between child maltreatment
and outcomes in middle adulthood. This study used abused and non-abused children. Due to the
child abuse, some participants reported engaging in risky behaviors such as sexual intercourse
(97.2%), alcohol use (78.8), and drug use (69.4), and more than half of the sample (50.4) had a
criminal arrest. This study found that child abuse and neglect plays in relation to early-onset risk
behaviors. Horon and Widom (2014), was the only study to determine that victims of childhood
abuse are more likely to engage in sexual activity and to be arrested at an earlier age.
Discussion/Implications
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The results of the research articles discussed the effects of childhood abuse on mental
health in adulthood. The articles provided different effects of child abuse on adulthood mental
health. The PICOT question specifically asked if there was a relationship between childhood
abuse and the effects on the mental health in adulthood? The qualitative study that was
completed by Unger and De Luca (2014), indicated that there is a relationship between child
abuse and the effects on adulthood based on the individual attachment to a person. While the
qualitative study done by Easton et al (2010), showed two factors negatively affected all the
dimensions of psychosexual functioning: age at the time of abuse and telling someone at the time
of the abuse. Being older at the time of the abuse increased the likelihood of being afraid of sex
and feeling of guilty during sex and increased the likelihood of being dissatisfied with sex during
adulthood. All the studies recognized the differences in obtaining data. One of the studies chose
a psychology class to gather data, another chose to get responses through a newspaper in a
community, and another chose to interview those that were abused and others that were not to
The implications of the findings suggest that there is a huge public health problem which
is preventable, but extremely hard to deal with. There are several programs out there to assist
with nurturing relationships and to promote a safe environment that could possibly reduce the
maltreatment of children, which can be found on the Centers for Disease Control and Prevention
website. Although, there is limited research available on the association between child abuse and
the effects on mental illness in adulthood, there is still a need of reporting abuse from the victim
as well as healthcare providers, especially nurses and also the need of treatment for all victims of
child abuse.
Limitations
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There were several limitations that the researcher recognized that influenced this
integrative review. This is the first time the researcher has completed an integrative review, so a
lack of experience limited the researchers ability to accurately provide an integrative review.
The lack of time available to complete this assignment and the students personal life effected
Conclusion
The findings in this integrative review highlight the association between child abuse and
the effects on the mental health in adulthood. Although, there were various factors that have to
be considered, overall treatment suggests a better outcome for adults who were abused as a child.
E. Fuller-Thomson et al (2012), concluded that child abuse has a significant impact on anxiety,
and the relationships that the individual has with others. Further research would help the
different methods that were used. Majority of the studies used a self-report method to gather
data, which creates a bias. Regarding the participants, the researcher believes using a broader
group. The studies focused on specific group and areas, which is a major limitation. Overall,
health care professionals and others could possibly benefit from the studies by having the ability
to recognize abuse and reporting it based on the signs and symptoms that were mentioned in the
previous articles. The major outcome of this is that there is an association between child abuse
and the overall mental health of adults. The earlier help is received the better the outcome for the
future.
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References
Easton, S. D., Coohey, C., Oleary, P., Zhang, Y., & Hua, L. (2010). The Effect of
Fuller-Thomson, E., Sohn, H., Brennenstuhl, S., & Baker, T. (2012). Is childhood
Horan, J. M., & Widom, C. S. (2014). Does Age of Onset of Risk Behaviors Mediate the
doi:10.1007/s10964-014-0161-4
Saha, I., Paul, B., Das, D. K., Dinda, J., Mukherjee, A., & Basu, S. (2012). Repeated
doi:10.1007/s10896-012-9481-x
Unger, J. A., & De Luca, R. V. (2014). The Relationship Between Childhood Physical
Abuse and Adult Attachment Styles. Journal of Family Violence, 29(3), 223-234.
doi:10.1007/s10896-014-9588-3
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Sample/ Setting/Ethical - 552 female and 294 male university students recruited from the
Considerations Introductory Psychology classes at the University of Manitoba
Appraisal/Worth to practice - Based on the findings, results have implications for individual
treatment approaches for child abuse victims
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First Author Scott D. Easton, PhD, 2011, School of Social Work, University of Iowa
(Year)/Qualifications
Background/Problem - How characteristics of childhood sexual abuse and disclosure influenced
Statement three dimensions of psychosexual functioning emotional, behavioral,
and evaluative during adulthood. There was a combination of problems
with the fear of sex, guilt, and problems with touch in adulthood.
Sample/ Setting/Ethical - 165 adults ages 20 and older sexually abused as children only
Considerations - Majority were female
- Completed high school or fewer years of education
- 20s (22.2%), 30s (33.9), 40s (23.6), and 50s or older (20.0)
Major Variables Studied (and - Age, gender, employment, or rural/urban residence were not related to
their definition), if appropriate the dependent variables
- Variables used: emotional dimension of sexual functioning whether the
sexual abuse resulted in being afraid of sex and in feeling guilty during
sex; Behavioral dimensions of sexual functioning whether the sexual
abuse resulted in having problems with being touched and in being
unable to be sexually aroused; Evaluative dimension whether the
abuse resulted in being dissatisfied with sex
Measurement Tool/Data - Data collection method: telephone interview
Collection Method
Findings/Discussion - Respondents who were older at the time of the abuse were more likely to
experience problems related to the emotional dimension of sexual
functioning than the respondents who were younger
- Being injured during the sexual abuse also appeared to be related to
fear of sex
- Telling had a negative effect on feelings of guilt
Appraisal/Worth to - It is important when treating adults with histories of CSA who report
practice problems in sexual abuse functioning the following need to be assessed:
how old the clients were when they were abused, how severe the abuse
was, and whether they told someone.
- All three dimensions need to be assessed
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First Author Jacqueline M. Horan, PhD, 2014., Psychology Dept., John Jay College of
(Year)/Qualifications Criminal Justice; Forensic Psychology.
Background/Problem - Child maltreatment linked with risky behaviors in adulthood
Statement - Study examines whether the ages of onset of four risk behaviors
sexual intercourse, alcohol use, drug use, and criminal behavior
mediate relationship between child maltreatment and outcomes in
middle adulthood
Data Analysis - MPlus 7.0 Structural equation modeling was utilized to test full models with
the mediating variable that supported by simple regression analysis
- Tucker -Lewis index
Findings/Discussion - Indications that abused and neglected children are more likely to
engage in sexual intercourse and criminal behavior
- Early engagement in risk behaviors mediated the relationship between
child abuse and neglect and several outcomes in middle adulthood.
Appraisal/Worth to practice - This study highlights the importance of child abuse and neglect plays in
relation to early-onset risk behaviors and later maladaptive functioning across
multiple domains
- More likely to engage in early-onset sexual activity and to be arrested at an
earlier age compared to non-maltreated youths
- Additional research needs to be done such as impacts of genetic and
environmental factors other than child abuse and neglect that may help with
the understanding of maladaptive results
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Design/ - Data from the 2005 cycle of the Canadian Community Health
Method/Philosophical Survey conducted by Statistics Canada;
Underpinnings - in depth interview
- Cluster design
Findings/Discussion - This study found a relationship between CPA and adult anxiety disorders
with the factors of demographics, family background, current SES, and
stressors
- CPA and anxiety disorders controlled for a depression history
- Adults currently reporting anxiety disorders in the current study is lower
than that reported elsewhere
- Individuals with mental health issues are less likely to seek medical care
and less likely to receive a diagnosis
Appraisal/Worth to practice - Since this study used self-report of abuse history may have
introduced some response bias.
- Using a s diagnostic criteria may help with the getting accurate
information for the study.
- There may be an association between CPA and anxiety, explained
by co-morbid mood disorders
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First Author Indranil Saha, MD, 2012, MBBS (Cal), MD (Psychiatry), DPM.
(Year)/Qualifications Specializes in Neuropsychiatry
Background/Problem Long-term abuse consequences of childhood abuse are the
Statement development of suicidal tendencies.
Sample/ Setting/Ethical - One patient; interview with patient at local clinic and at home
Considerations
Data Analysis
Appraisal/Worth to practice - Although this was probably not the best article it provided an
outcome of child abuse and neglect and the effects of it through
one persons eyes
- Could this be used alone to integrate this into practice probably not,
but it gives a different outlook unlike the other articles