Psychological Impact and Differences in Child and Adolescent Victims of Sexual Violence in South Korea: Using Data From a Sunflower Center in South Korea From 2015 to 2022
Article information
Abstract
Objective
Sexual violence against children and adolescents is a serious social problem. The characteristics of child and adolescent victims differ based on their varying developmental processes. Therefore, we conducted a comparative analysis to assess the same.
Methods
Data were collected from victims of sexual violence between 2015 and 2022, from a Sunflower Center, which is a government-sponsored center for victims of sexual violence. The participants were classified into two groups: children under age 12 and adolescents over age 13 years. To compare and analyze data, we collected demographic information, information related to victimization events, and scores on the Children’s Depression Inventory, Revised Children’s Manifest Anxiety Scale, and Children’s Revised Impact of Event Scale. A descriptive analysis, χ2 test, Fisher’s exact test, and multiple logistic regression analysis were performed.
Results
Among 255 participants, 95 and 160 were children and adolescents, respectively. The percentage of forced molestation was significantly higher in children at 71.6% (n=68, p<0.001). Children included significantly more male participants (14.7%, n=14, p=0.007) than adolescents. Significant differences were observed between children and adolescents’ depression, anxiety, and posttraumatic stress scores (p<0.001). Compared with children, adolescents demonstrated an adjusted odds ratio of 2.9 for high post-traumatic stress symptoms, 2.26 for high depressive symptoms, and 3.0 for high anxiety symptoms.
Conclusion
We identified differences in the characteristics of sexual violence victims, particularly children and adolescents, and found that adolescent victims were more vulnerable to the psychological repercussions of abuse than child victims.
INTRODUCTION
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.
METHODS
Participants and procedure
Data were obtained from records at the Sunflower Center of Northwestern Gyeonggi for Women and Children Victims of Violence in South Korea. The Sunflower Center is a government-funded, hospital-based, crisis intervention service center that provides counseling, legal and investigative support, and medical and psychological treatment for victims of sexual and domestic violence and sex trafficking in Korea [8]. For the present study, we retrospectively evaluated the records of victims who had visited the center between January 2015 and December 2022 and included victims of sexual violence.
Among the records of victim data, data on children and adolescents under 18 years of age were included. These groups were classified into children under 12 years of age (CA) and adolescents over 13 years of age (AD). The collected data included participants’ demographic information (sex, age, and disability) and information related to the victimization cases (presence of a video or photo at the time of victimization, past sexual victimization experience, psychiatric history, number of perpetrators, number of times of victimization by the same perpetrator, relationship with the perpetrator, age of the perpetrator, motive for visiting the center, time of case filing, and criminal trial court results). The victims completed three psychological scales to evaluate their depression, anxiety, and post-traumatic stress symptoms.
Measures
The Children’s Depression Inventory (CDI) was developed by Kovacs to measure the depression levels of school-aged children and adolescents [9]. The Korean version of the CDI has sound reliability and validity [10]. It comprises 27 items, and each item comprises 3 statements. The total CDI scores range from 0 to 54. A score of 29 or above represents “high” depressive symptoms in this study.
The Revised Children’s Manifest Anxiety Scale (RCMAS) was developed by Castenada, McCandlless, and Palermo to measure the anxiety levels of children and adolescents; the scale was revised by Reynolds and Richmond [11]. It comprises 37 yes/no items about anxiety. The Korean version of the RCMAS, translated by Choi and Cho [12], has adequate internal consistency. The total score of the RCMAS ranges from 0 to 37. A score of 19 or above is classified as “high” in this study.
The Children’s Revised Impact of Event Scale (CRIES) comprises 13 items measuring posttraumatic stress disorder (PTSD) symptoms and evaluates children who have been exposed to traumatic events and are at risk of experiencing PTSD [13]. The Korean version of the CRIES demonstrates adequate levels of internal consistency [14]. The total score of CRIES ranges from 0 to 65. A score of 38 or above is classified as “high” in this study.
Statistical analysis
We computed the descriptive statistics for the demographic characteristics of the victims and characteristics related to sexual violence. The comparisons between the two groups (children and adolescents) and the characteristics of the abuse were examined using the χ2 test and Fisher’s exact test for categorical variables and the t-test for continuous variables. A multiple logistic regression was implemented to explore the associations between scores on the CRIES, CDI, and RCMAS, and victims’ characteristics. We also reported the adjusted odds ratios (AORs) and 95% confidence intervals. All statistical analyses were performed using SAS version 9.4. (SAS Institute Inc.), and statistical significance was set at p<0.05.
Ethics statement
The present study was reviewed and approved by the Institutional Review Board of Myongji Hospital (IRB No. MJH 2023-11-036). The requirement for informed consent was waived owing to the retrospective design of the study.
RESULTS
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.
Comparison of the characteristics of children and adolescent victims
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.
Distribution of total scores on the psychological scales (CRIES, CDI, and RCMAS)
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.
Association between victims’ characteristics and psychological impact using multiple logistic regression
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.
DISCUSSION
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.
Notes
Availability of Data and Material
The datasets generated or analyzed during the study are not publicly available due to privacy and ethical restrictions related to sensitive victim information collected by the Sunflower Center, but are available from the corresponding author on reasonable request.
Conflicts of Interest
Minha Hong, a contributing editor of the Psychiatry Investigation, was not involved in the editorial evaluation or decision to publish this article. All remaining authors have declared no conflicts of interest.
Author Contributions
Conceptualization: Minha Hong. Data curation: Changwoo Han, Seunghoon Lee, Jin Sun Ryu. Formal analysis: Kyoung-Hoon Kim. Methodology: Kyoung-Hoon Kim, Sang Min Lee, Ah Rah Lee. Investigation: Sang Min Lee, Jiali Emily Koh. Writing—original draft: Minha Hong. Writing—review & editing: Minha Hong, Hyun-Soo Kim.
Funding Statement
None
Acknowledgments
The authors would like to express their deepest gratitude to the Gyeonggi Northwest Sunflower Center and to the center’s psychological team. We are also profoundly thankful to former Deputy Director Ms. Kim So-hyang and current Deputy Director Ms. Cho Young Ran for their unwavering support and dedication, which greatly contributed to the successful completion of this study.