Despite being an extremely serious and critical form of violence that must be eradicated, sexual violence exists in every society. However, the accurate assessment of its prevalence is difficult. Among sexual violence crimes, sexual violence against children and adolescents is a globally recognized public concern, constituting a tragedy for the victims, their families, and society as a whole. The child and adolescent populations are in the process of undergoing developmental changes and brain maturation, which makes the impact of severe adverse life events, such as sexual violence, on their mental health highly detrimental in the short and long run [1].

Significant differences exist between minors and adults; therefore, age must be considered an important factor. Minors and adults are typically classified into distinct groups; within the category of minors, a further distinction is made between children and adolescents to compare their characteristics. These two groups exhibit considerable differences in their development, perception of events, and responses to traumatic incidents, making them highly heterogeneous. Therefore, comparing these groups is both meaningful and valuable, and the results can provide substantial insights for professionals in relevant fields, such as psychologists, social workers, therapists, and criminal justice professionals. An early study by Feiring et al. [2] analyzed interviews conducted within eight weeks after the incident with a sample of 169 children (aged 8-11) and adolescents (aged 12-15) who had been identified higher levels of depressive symptoms and negative reactions from others, while showing lower levels of self-esteem, social support, and sexual anxiety. Another study reviewed and analyzed 3,430 allegations of child sexual abuse cases in Canada, examining the characteristics of child and adolescent plaintiffs [3]. However, it focused on a legal perspective rather than psychological aspects. Additionally, a study conducted in Spain using two years of data analyzed the risk factors and characteristics of child, adolescent, and adult victims [4]. And there is also study comparing adult and adolescent victims [5]. In South Korea, studies have compared the physical aspects of children and adolescents and have prospectively tracked the psychological aftermath of sexual violence [6,7]. However, no research has specifically focused on a comparative analysis of the psychological aspects of child and adolescent victims. Therefore, this study holds significant value in addressing this gap.

This study aimed to compare and analyze the demographic and general characteristics of children and adolescents who have been victims of sexual violence and examine the differences in the psychological impacts of such abuse.

Among the 255 participants, 95 were children and 160 were adolescents. A comparison of the characteristics of the children and adolescents is presented in Table 1. In the CA group, forced molestation was significantly more prevalent at 71.6% (n=68, p<0.001) than in the AD group. Significantly more male victims were observed in the CA group at 14.7% (n=14, p=0.007) than in the AD group. Moreover, the CA group had significantly more cases with no previous sexual victimization by other perpetrators (97.9%, n=93). They also had significantly more cases where the victim had met the perpetrator for the first time on the day of victimization (30.5%, n=29, p=0.017). The percentage of voluntary visits to the center was significantly higher in the CA group (13.7%) than in the AD group (6.3%, p=0.045). Individuals reporting the case within a week were significantly higher in the CA group (51.6%) than in the AD group (36.3%, p<0.001). No differences were observed between the groups in terms of disability, psychiatric history, number of perpetrators, or the age of perpetrators.

The psychological scale results are shown in Table 2. In terms of the PTSD symptoms measured by the CRIES, 32.6% of those in the CA group and 61.3% of those in the AD group experienced high symptoms. In terms of the depressive symptoms measured by the CDI, 15.8% of those in the CA group were classified as having high symptoms, compared with 37.5% of those in the AD group. In terms of the anxiety symptoms measured by the RCMAS, 46.3% of those in the CA group had high symptoms, compared with 78.1% of those in the AD group.

The results of the logistic regression analysis are presented in Table 3. Compared with the CA group, the AD group demonstrated higher AORs for high PTSD symptoms at 2.955, high depressive symptoms at 2.262, and high anxiety symptoms at 3.018.

For individuals with a history of sexual victimization, the AOR for high depressive symptoms was 4.165, whereas for those with a psychiatric history, the AOR for high depressive symptoms was 7.134.

In terms of the timing of case registration after the incident, the cases registered within one to three months were compared with those in the reference group (within one week). The AORs for high PTSD, depressive, and anxiety symptoms were 5.072, 2.812, and 3.394, respectively. For cases registered more than three months after the incident, the AORs for high depressive and anxiety symptoms were 3.050 and 3.733, respectively.

To the best of our knowledge, this study is the first in Korea to compare and analyze child and adolescent victims of sexual violence; such studies are rare worldwide. Significant differences were identified between child and adolescent victims in terms of victim- and incident-related factors. Additionally, in terms of the psychological impact, we found that child victims exhibited significantly higher levels of PTSD symptoms, depression, and anxiety than adolescent victims.

Specifically, the study revealed that compared with children, adolescents demonstrated 2.9 times higher levels of high PTSD symptoms (as measured by the CRIES), 2.26 times higher levels of high depressive symptoms (as measured by the CDI), and 3.0 times higher levels of high anxiety symptoms (as measured by the RCMAS). These findings suggest that adolescents are more vulnerable to the psychological harm caused by sexual violence than children.

This study found that the proportion of females was lower in the child group than in the adolescent group, which is consistent with findings from various studies in the literature [2,15,16]. This difference partly explained by the idea that adolescent girls might be more likely to report sexual violence compared to younger children or boys, potentially due to increased awareness or a greater ability to articulate their experiences [17].

In this study, the rate of voluntary center visit was 13.7% in the child group and 6.3% in the adolescent group, showing a twofold higher rate in the child group. This finding contradicts previous studies, which suggest that younger children are less likely to disclose voluntarily compared to adolescents [18]. This discrepancy suggests that other than age alone, such as intelligence, parental involvement, perceived support systems, or varying levels of external prompting, may influence voluntary disclosure [19]. Further research is needed to explore the underlying mechanisms that contribute to these differences and to better understand the factors that facilitate or hinder voluntary disclosure across different age groups.

In this study, the fact that the perpetrator of sexual violence was the first person to meet was more pronounced among children than among adolescents. A study by da Costa et al. [20] found that the primary perpetrators were brothers and friends in the group of victims under 15 years of age, whereas strangers and friends were the main perpetrators in the 15-19 age group. Similarly, Giroux et al. [3] noted that compared with adolescents, children were more likely to be abused by parents or relatives. Although these findings differ from ours, we believe that further research into different social contexts, such as studying the scope of social interactions across cultures, is necessary to better understand these differences. Additionally, the increasing prevalence of sexual violence facilitated through digital media and the inclusion of victims from the COVID-19 pandemic (2020-2022) may also contribute to the discrepancies between previous studies and our findings. We suggest that these factors be considered in future research to gain a more comprehensive understanding of the differences observed.

In terms of the timing of reporting the incident to the Sunflower Center, the reference point was set to within one week. We found that compared with the reference group, those who reported the incident within one to three months experienced 5.0 times higher levels of high PTSD symptoms, 3.39 times higher levels of high anxiety symptoms, and 2.8 times higher levels of high depressive symptoms. For those reporting the incident after more than three months, anxiety and depression were 3.7 and 3.0 times higher, respectively. This suggests that the delay in reporting might be due to a longer period of contemplation or that the victim may have initially downplayed the severity of the incident, deciding to report it later. Alternatively, the victim may have initially dismissed the trauma and later recognized its impact. However, for professionals in the field who encounter victims within one to three months after the incident, approaching them with the understanding that they may be significantly affected by the psychological consequences of the trauma would be reasonable. The professional should avoid assuming that the victim waited this long because the incident was not serious.

Interestingly, the types of victimization, including forced molestation, forcible sexual penetration, and rape, did not show statistically significant differences in their psychological impact.

A key strength of this study was its focus on a particularly challenging and sensitive group, namely, child and adolescent victims of sexual violence. While the data were collected from a single government-sponsored center, the study benefited from the homogeneity of the regional population and the relatively large sample size collected over an eight-year period. Given the sensitive nature of sexual violence, which often leads victims to conceal their experiences rather than disclose them, conducting research on this topic is inherently difficult. The strength of this study lies in its ability to explore the psychological impact of sexual violence on this vulnerable population, offering valuable contributions to the field and existing literature.

The limitations of this study are as follows. First, as the data were collected from a single center, the findings may not be generalizable to broader populations, and caution should be exercised when applying these results to different contexts. Second, owing to the cross-sectional design of the study, causal relationships between the variables could not be established. Third, while the study focused on the psychological impact of sexual violence, it did not assess pre- and post-intervention outcomes, which limited our understanding of the effects of interventions. Finally, future research should consider using well-designed cohort studies to examine the long-term psychological outcomes of sexual violence, as this remains a crucial area for further investigation.

In conclusion, this study highlighted the differences between children and adolescents exposed to sexual violence, particularly emphasizing that adolescents are more vulnerable to psychological trauma than children. Additionally, we found that psychological distress remained significantly higher even after a period of 1-3 months following the incident, before the victims were admitted to the center. While these findings should be further verified through causal analysis and other factors in well-designed prospective cohort studies, we believe that the current results will make a valuable contribution to the development of related policies and to guiding victim support strategies.