Corresponding author: Marie-Claude Geoffroy, Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, H3A 1Y2, Montreal, Quebec, Canada [email protected], 514-398-2817

ABSTRACT

Introduction: Child sexual abuse remains a worldwide concern with devastating consequences on an individual’s life. This longitudinal study investigates associations of child sexual abuse (official reports vs. retrospective self-reports) and subgroups by perpetrator identity (intra, extrafamilial), severity (penetration/attempted penetration, fondling/touching, non-contact), and chronicity (single, multiple episodes) and employmen t earnings in adulthood in a cohort followed for over 30 years.

Methods: The Quebec Longitudinal Study of Kindergarten Children database was linked to child protection services (official reports of sexual abuse) and to Canadian government tax returns (earned income). The sample included 3020 individuals in Quebec French-language school kindergartens in 1986/1988, followed until 2017 and assessed with retrospective self-reports at age 22. Tobit regressions were used for associations with earnings (ages 33-37), adjusting for sex and family socioeconomic characteristics in 2021-2022.

Results: Individuals who experienced child sexual abuse had lower annual earnings. Those with retrospective self-reported sexual abuse (n=340) earned US$4031 (95%CI:-7134;-931) less annually at ages 33-37 than non-abused individuals (n=1320), with pronounced differences for those with official reports (n=20), earning US$16,042 (95%CI:-27,465; -4618) less. Individuals self-reporting intrafamilial sexual abuse earned US$4696 (-9316; -75) less than those who experienced extrafamilial sexual abuse while those self-reporting penetration/attempted penetration earned US$6188 (95%CI:-12,248; -129) less than those who experienced non-contact sexual abuse.

Conclusions: Earnings gaps were highest for severest child sexual abuse (official reports, intrafamilial, penetrative). Future studies should investigate underlying mechanisms. Improving support for victims of child sexual abuse could yield socioeconomic returns.

KEYWORDS: Child sexual abuse, sexual abuse, annual income, income gap, earnings, penetrative sexual abuse, intrafamilial sexual abuse, child protection services, Quebec Longitudinal Study of Kindergarten Children

INTRODUCTION

Child sexual abuse – defined as any completed/attempted sexual act/contact or non-contact sexual interaction with a child¹ – is a worldwide concern, as it is associated with a range of adverse outcomes through life.^1-4 In Canada, and elswhere,⁵ sexual abuse is common with self-reported prevalence of 14.4% for women and 5.8% for men,⁶ although fewer instances of abuse are reported to authorities.⁷

Long-term studies show that adverse childhood experiences⁸ or child maltreatment (e.g., abuse or neglect)⁵ are associated with poor socioeconomic outcomes in adulthood, but few studies have focused specifically on sexual abuse. A recent systematic review of child sexual abuse and adult socioeconomic outcomes (e.g., employment status, annual earnings, welfare) identified only 5 studies examining associations, but findings were inconsistent⁹ and undermined by methodological limitations. First, most studies of child sexual abuse have measured socioeconomic outcomes in early-adulthood,^10-12 an age characterized by financial instability and occupational uncertainty, especially for women.¹³ Consequently, any association of child sexual abuse with socioeconomic outcomes may manifest only later in adulthood, after the establishment of stable employment. Second, to our knowledge, all studies^10,11,14-16 have been limited by a loss of participants over time – especially vulnerable participants – leading to potential underestimation of the true association. Third, studies have mainly examined self-reported socioeconomic outcomes, which are prone to reporting bias.¹⁷ Fourth, most studies have relied on single unvalidated measures of sexual abuse,^10,12,16 with no consideration of subgroups such as severity, chronicity, or perpetrator identity. Intrafamilial abuse, for instance, is known to be associated with poorer mental health than extrafamilial abuse.¹⁸ One study based on a sample of 248 women found that penetrative sexual abuse was associated with a decline in socioeconomic status, as compared to non-contact sexual abuse.¹⁴ Finally, most studies^10,11,16 have assessed sexual abuse using retrospective questionnaires, overlooking differential associations between officially reported or unrecognized sexual abuse with socioeconomic outcomes. Given that poor socioeconomic status is a well-known risk factor for mental and physical health problems,^1-3,19 and future intergenerational transmission of sexual abuse,²⁰ it is essential to document the breadth of long-term consequences using robust methods.

This study sought to fill these gaps using the Quebec Longitudinal Study of Kindergarten Children (QLSKC), a large population-based cohort linked with administrative data that provides a unique opportunity to document long-term associations into middle-age. It includes sexual abuse reported to authorities, as well as retrospective self-reports indicating perpetrator, chronicity, and severity of abuse. Linking the QLSKC database to federal taxation databases provides objective measures of income from 18-37 years. The use of administrative income data improves sample representativeness, data accuracy, and helps to overcome limitations of previous studies. To our knowledge, this is the first longitudinal study to investigate associations of child sexual abuse (official reports vs. retrospective self-reports) and subgroups by perpetrator (intra- vs. extrafamilial), severity (penetration/attempted penetration vs. fondling/touching vs. non-contact), and chronicity (single vs. multiple episodes) and employment earnings using tax records in adulthood.

Results can inform public health departments and policymakers about the economic disparities associated with child sexual abuse and underscore the need for sound investment to support survivors of child sexual abuse.

METHODS

Study Population

A database linkage study with the QLSKC was conducted, using participant’s identifying information, such as name and birthdate, linking cohort participants to Quebec Child and Youth Protection Services databases and to Canadian government tax return records. Official reports of sexual abuse (ages 0-18, as filed with child protection services) and retrospective self-reports (age 22) were examined and associations of child sexual abuse with employment earnings at ages 33-37 were investigated.

The QLSKC is a longitudinal cohort of 3020 children recruited in kindergarten in French-language public schools in Quebec, Canada, during the 1986-87 and 1987-88 school years and followed until 2017.²¹ Of these, 2000 children (1001 boys (50.5%) and 999 girls (49.9%)) were representative of Quebec kindergarten schoolchildren (random sample) and 1020 children (600 boys (58.8%) and 420 girls (41.2%)) were oversampled for disruptive behaviour, as defined by a score ≥80th percentile on the Disruptive Behaviour Scale of the Social Behaviour Questionnaire.²² Cohort membership (disruptive sample vs. not) was used as a control variable.²³ Ethics approval was obtained from the University of Montreal Research Ethics Board and Statistics Canada. Participants or their parents, provided written informed consent at each QLSKC assessment period.

Measures

Official reports of child sexual abuse before age 18 were extracted from database linkage with Quebec Child and Youth Protection Services (i.e., receiving all reports concerning children who may be in need of protection, evaluate them, and ensure protection). For the purposes of this study, all notifications of sexual abuse to youth protection services were included, regardless of substantiation (n=20).

Self-reported incidence of child sexual abuse (collected at age 22) were obtained directly from the QLSKC database. Participants retrospectively answered five questions adapted from the Adverse Childhood Experiences Questionnaire^24,25 and the Sexually Victimized Children Questionnaire.²⁶ Questions included any unwanted sexual acts in the form of exhibitionism, sexual fondling/touching, penetration/attempted penetration by bribe, threats or force, or by drugs and/or alcohol before age 18; e.g., “Did someone show you their sexual parts or force you to show them your sexual parts when you did not want to?” If participants responded “yes”, they were asked about their relationship to the perpetrator (within the family, within the extended family, acquaintance from school, or stranger) and the frequency of abuse (one time or more). Three variables were created characterizing abuse: 1) type (perpetrator): intrafamilial (parents, siblings, relative) vs. extrafamilial (stranger, acquaintance from school); 2) severity: penetration/attempted penetration vs. sexual fondling/touching vs. non-contact (exhibitionism, voyeurism); and 3) chronicity: one episode vs. multiple episodes.

Employment earnings were obtained annually from ages 18-37 years (1998-2017) from federal government income tax returns (Statistics Canada) and linked to the QLSKC cohort.²⁷ For the purpose of the present study, only income from ages 33-37 was used. Pre-tax wages, salaries, and commissions were included, excluding income from capital gains. To control for random yearly variations in present-day earnings, the mean of the 5 most recent tax returns (ages 33-37) was used. For ease of comparability, all financial data were converted to US dollars prior to analysis, using the current purchasing power parity exchange rate (1CAD=0.83USD).

Childhood socioeconomic characteristics known to be associated with child sexual abuse^11,28,29 and later socioeconomic outcomes;³⁰ namely, parental earnings, parental education level, parental age at childbirth (average of maternal and paternal ages), family unit (single-parent vs. two-parent family), child’s sex, and child’s disruptive behaviour (being part of “disruptive” sample) were controlled for. Data on parental earnings for the years 1982-1987 (child ages 2-7) was obtained from Canadian government tax returns. Other characteristics in the QLSKC database were collected through questionnaires completed by the mother at participant age 6.

Statistical Analysis

Data were analyzed using SPSS version 24 (IBM Corporation, Armonk/NY) and R version 3.6.2 (R Core Team, R Foundation for Statistical Computing, Vienna/Austria) in 2021/22. The prevalence of sexual abuse and childhood socioeconomic correlates of child sexual abuse in the sample (N=3020) was investigated, using four non-overlapping categories: (1) no official reports or retrospective self-reports of sexual abuse; (2) no officially reported sexual abuse and “missing” retrospective self-report; (3) no officially reported sexual abuse but retrospective self-reports; (4) officially reported sexual abuse. Next, Tobit regressions were used to investigate associations between child sexual abuse and average employment earnings in the last 5 years (ages 33-37), left-censored at $0. To reduce the effect of extreme outliers, income scores at or above the 99^th percentile were winsorized. Sex of the child, disruptive sample membership, and socioeconomic characteristics in childhood were controlled for, using three models: (1) unadjusted; (2) adjusted for sex; and (3) adjusted for childhood socioeconomic characteristics. All models controlled for being in the disruptive sample.

Missing values on childhood characteristics ranged from 0% (sex) to 30% (family unit). To avoid losing participants, missing values on potential confounders were imputed using multiple imputation by chained equations;³¹ analyses were conducted across 50 pooled imputed datasets.

All analyses for associations of abuse with economic outcome were examined for official and/or self-reported abuse, as well as for perpetrator, severity, and chronicity of abuse in individuals with retrospective self-reports of abuse.

RESULTS

Of the 3020 participants, 1320 (43.7%) reported no sexual abuse and 1340 (44.3%) had no official report but were missing retrospective questionnaires (e.g., could not be contacted, traced, or refused). 340 (11.3%) had no official report but had retrospectively self-reported sexual abuse, and 20 (0.7%) had official reports to youth protection services (with/without retrospective self-reports), including 10 individuals with concurrent retrospective reports including abuse characteristics (type, severity, and chronicity; Appendix Table 1).

For self-reported abuse, about twice as many of the 350 participants reported extrafamilial than intrafamilial abuse (Appendix Table 1). The prevalence of penetration/attempted penetration was about the same as that of fondling/sexual touching (38-40% each); the prevalence of non-contact sexual abuse was less. Most abuse was single-episode (82%). Participants who were sexually abused were more likely to come from underprivileged homes with lower parental education and earnings than those who were not sexually abused (Appendix Table 2). Participants with intrafamilial vs. extrafamilial sexual abuse more often had a father with no college education. Participants who suffered penetration vs. fondling/touching vs. non-contact sexual abuse were more likely to come from slightly lower-income families (Appendix Table 3).

The association between child sexual abuse and later employment earnings at ages 18 to 37 years is illustrated in Figures 1 and 2. Participants who experienced sexual abuse earned less than non-abused participants; those with officially reported sexual abuse had the lowest earnings, over the entire follow-up period. The average annual earned income in the last 5 years (ages 33-37) was US$32,800 ± 24,840. Analyses controlling for sex, disruptive behaviour, and socioeconomic characteristics in childhood are shown in Table 1. Individuals with self-reported sexual abuse earned an average US$4031/year less (95%CI:-7134;-931) than those not abused. Individuals with official reports earned US$16,042/year less (95%CI:-27,465;-4618) than those not abused. Individuals with no official report and missing a retrospective report also had lower annual earnings, but this decrease was not statistically significant: US$1906/year (95%CI:-3912;98).

As illustrated in Figures 2A and 2B, participants who experienced intrafamilial abuse or penetration/attempted penetration earned less from young to mid-adulthood than those who experienced extrafamilial abuse or non-contact sexual abuse, respectively. No difference was observed for chronicity of abuse (Figure 2C). Fully adjusted analyses at 33-37 years (Table 2) showed that individuals who experienced intrafamilial abuse earned on average US$4696/year (95%CI:-9316;-75) less than those with extrafamilial abuse. Individuals who experienced penetration/attempted penetration earned US$6188/year (95%CI:-12,248;-129) less than those with non-contact sexual abuse. No significant differences in earnings were observed for sexual touching vs. non-contact abuse and for chronicity. Results based on non-imputed values were similar in essence to main results (Appendix Table 4 and Appendix Table 5).

To verify the robustness of the results, three sensitivity analyses were conducted. First, 1350 participants with missing information on retrospectively reported abuse were excluded; associations of official and retrospective sexual abuse with earnings remained unchanged (Appendix Table 6). Second, models examining characteristics of sexual abuse with earning were stratified by sex. As shown in Appendix Table 7, associations were seen in females, but not in males. Third, self-reported physical abuse was controlled for (retrospectively assessed at 22 years using the Parent-Child Conflict Tactics Scale).^33,34 This did not abolished associations of official and retrospective abuse (Appendix Table 8 and Table 9).

DISCUSSION

To our knowledge, this is the first longitudinal study to investigate associations between child sexual abuse and long-term employment earnings by mid-adulthood. Linking data from government income tax returns to a representative population-based cohort of over 3,000 participants, it was found that individuals who experienced child sexual abuse endured adverse long-term economic consequences in adulthood. Both officially reported and retrospectively self-reported child sexual abuse were investigated. It was found that adults who retrospectively self-reported having experienced intrafamilial sexual abuse, penetration/attempted penetration or official reports earned less at ages 33-37 than individuals not sexually abused. The estimates were robust, even after adjustment for a host of childhood confounders including parental earnings gathered from tax records, and physical abuse, assessed retrospectively.

The results are in line with some studies^8,16,35-38 but not others.^10-12 Previous studies had examined outcomes either in early-adulthood¹² or at mixed ages;¹⁰ or else on populations with all forms of child abuse confounded, not delimited as sexual.^8,39,40 Our results suggest that the earnings gap between individuals sexually abused and non-abused in childhood widens in the period from early-adulthood to mid-adulthood.

The study highlights that associations with employment earnings are most noticeable in the severest forms of child sexual abuse, namely those involving penetration/attempted penetration or an intrafamilial perpetrator. Such subgroup analyses could not have been done in earlier studies that used a single self-reported measure of abuse,^10,12,16 which might explain why no effect was found. For instance, participants abused by a family member earned about US$4,000/year less at ages 33-37 than those abused by a non-family member. This finding is in line with another study using the same cohort showing that the risk of attempted suicide at age 22 was 5-fold for sexual abuse by a family member compared to a non-family member.⁴¹

The largest income difference was observed in adults with an official report of child sexual abuse. Their mean annual earnings at ages 33-37 were about US$16,000 less than that of their non-abused counterparts. However, these results should be interpreted with caution: only 20 participants had official reports, with most experiencing other types of maltreatment. Nonetheless, this finding confirms results from a previous prospective cohort study of 807 males and females, with official records of child maltreatment and self-reported socioeconomic outcomes, showing that sexual abuse was associated with an income gap of US$8,000 at age 41 (in 2003-2004) and that abused individuals were less likely to be employed, be a skilled worker, own stock, or purchase their own vehicle or home.³⁶ Note, however, that notification of maltreatment to child protection services typically represents severe instances of abuse,⁴² often in conjunction with neglect and physical abuse.^7,43

Key confounding factors in childhood were taken into account, including parental household earnings. In a prior longitudinal study,¹¹ associations between child sexual abuse and gross income was lost after adjustment for childhood socioeconomic factors. Our results remained robust.

It would be of interest to elucidate intermediary pathways that could lead to actionable targets for prevention and intervention. Deficits in cognitive abilities and educational attainment,⁴⁴ poor physical health (obesity,³ gastrointestinal symptoms,⁴⁵ headaches⁴⁶) and poor mental health (depression,⁴⁷ anxiety,⁴⁸ substance use,⁴⁵ suicide attempts³²) could be potential mediators. In a longitudinal study of 496 individuals,⁴⁹ the effect of maltreatment on subsequent financial strain for sexual abuse survivors (self-reporting and prospective) was partially explained by depressive symptoms in adolescence. In contrast, in the 1958 British Birth Cohort, associations between retrospective reports of child abuse on financial insecurity and income-related support at age 50 were not mediated by cognitive abilities and mental health in adolescence.¹⁶ Further studies are needed to deepen our understanding of underlying mechanisms and to clarify inconsistent findings.

Limitations

This study has major strengths, primarily a large, representative, population-based cohort followed prospectively for almost four decades. Second, cohort and administrative databases were linked to obtain accurate information on employment earnings and sexual abuse, thus eliminating bias related to self-reporting (memory recall, desirability).^50,51 By adding retrospective self-reports of sexual abuse, large amounts of sensitive data were collected⁵⁰ and captured cases otherwise unreported.⁵² In Quebec, only 0.48 incidents for every 1,000 children are reported annually, and indeed only 20 participants had official reports.⁷ The retrospective reports, although prone to bias, enabled subgroup analysis on perpetrator, severity, and chronicity of abuse. Our adjusted models further controlled for key childhood confounders, including accurate parental earnings.

There were several methodological limitations. First, as about one-third of participants did not complete the sexual abuse questionnaire, true associations with employment earnings may have been underestimated. However, results remained in sensitivity analyses removing participants that were missing on the questionnaire. Second, child and parental mental health was not controlled for, thus income gaps may not be due solely to sexual abuse. Third, retrospective physical abuse was controlled for in sensitivity analyses, information on other types of maltreatment was not available. Fourth, despite a large cohort of over 3000, only 20 participants had official youth protection reports of sexual abuse, widening confidence intervals and pre-empted further subgroup analysis. For characteristics of abuse, associations were only found in females, however as fewer males were victims of child sexual abuse (60 males vs. 280 females), results should be interpreted with caution. Replication with a larger at-risk sample is recommended. Future studies are needed to assess the putative causal impact of child sexual abuse and employment earnings by using quasi-experimental design, such propensity scores weighting.

CONCLUSIONS

In summary, our findings suggest that child sexual abuse is associated with socioeconomic inequalities by mid-adulthood, particularly for severe forms of child sexual abuse (official reports, intrafamilial abuse, and penetration/attempted penetration). As earned income is a marker for healthy aging⁵³ and longevity,⁵⁴ and as optimal income can be protective against intergenerational continuity of abuse,⁵⁵ it is imperative to help victims reach their maximal economic potential. Prevention and therapeutic support would contribute to resilient functioning and yield significant social and economic returns for individuals and for society as a whole.

ACKNOWLEDGEMENTS

The authors are grateful to Danielle Buch, Medical Writer, Research, for critical revision and substantive editing of the entire manuscript. We would like to thank Alain Girard, the Research Unit on Children’s Psychosocial Maladjustment, the University of Montreal, and the Quebec Network on Suicide, Mood Disorders and Associated Disorders (RQSHA). The analyses presented in this paper were conducted at the Quebec Interuniversity Centre for Social Statistics (QICSS) which is part of the Canadian Research Data Centre Network (CRDCN). The services and activities provided by the QICSS are made possible by the financial or in-kind support of the Social Sciences and Humanities Research Council (SSHRC), the Canadian Institutes of Health Research (CIHR), the Canada Foundation for Innovation (CFI), Statistics Canada, the Fonds de recherche du Québec and the Quebec universities. The views expressed in this paper are those of the authors, and not necessarily those of the CRDCN, the QICSS or their partners.

Ms. Bouchard received a Master’s award from the Social Sciences and Humanities Research Council (SSHRC), as well as a grant from the Quebec Network on Suicide, Mood disorders, and Related Disorders. Dr. Vergunst was funded by the Canadian Institutes of Health Research (CIHR) and a Fonds de Recherche du Quebec – Santé (FRQS) postdoctoral fellowship. Drs. Ouellet-Morin (Tier 2), Hébert (Tier 1) and Geoffroy (Tier 2) hold a Canada Research Chair. Dr. Langevin is funded by the CIHR, Institut universitaire Jeunes en difficulté, and an Internal Social Sciences and Humanities Development Grant from McGill University. No other disclosures were reported.

Conflict of interest statement: Ms. Bouchard received a master’s award from the Social Sciences and Humanities Research Council, as well as the Quebec Network on Suicide, Mood disorders, and Related Disorders. Dr. Vergunst is funded by the Canadian Institute of Health Research (CIHR) and Fonds de Recherche du Quebec-Santé (FRQS) postdoctoral fellowship. Drs. Ouellet Morin, Hébert and Geoffroy hold a Canada Research Chair. No other disclosures were reported.
No financial disclosures were reported by the authors of this paper.

REFERENCES

1. Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009;373(9657):68-81. doi:10.1016/s0140-6736(08)61706-7

2. Clark C, Caldwell T, Power C, Stansfeld SA. Does the influence of childhood adversity on psychopathology persist across the lifecourse? A 45-year prospective epidemiologic study. Ann Epidemiol. 2010;20(5):385-94. doi:10.1016/j.annepidem.2010.02.008

3. Power C, Pinto Pereira SM, Li L. Childhood maltreatment and BMI trajectories to mid-adult life: Follow-up to age 50y in a British birth cohort. PLoS One. 2015;10(3):e0119985. doi:10.1371/journal.pone.0119985

4. Hailes HP, Yu R, Danese A, Fazel S. Long-term outcomes of childhood sexual abuse: An umbrella review. Lancet Psychiatry. 2019;6(10):830-839. doi:10.1016/s2215-0366(19)30286-x

5. Barth J, Bermetz L, Heim E, Trelle S, Tonia T. The current prevalence of child sexual abuse worldwide: A systematic review and meta-analysis. Int J Public Health. 2013;58(3):469-83. doi:10.1007/s00038-012-0426-1

6. Afifi TO, MacMillan HL, Boyle M, Taillieu T, Cheung K, Sareen J. Child abuse and mental disorders in Canada. CMAJ. 2014;186(9):E324-32. doi:10.1503/cmaj.131792

7. Hélie S, Collin-Vézina D, Turcotte D, Trocmé N, Girouard N. Étude d’incidence québécoise sur les situations évaluées en protection de la jeunesse en 2014 (ÉIQ-2014). Rapport Final. 2017:1-115. https://cwrp.ca/publications/quebec-incidence-study-2014-eiq-2014-final-report

8. Metzler M, Merrick MT, Klevens J, Ports KA, Ford DC. Adverse childhood experiences and life opportunities: Shifting the narrative. Child Youth Serv Rev. 2017;72:141-149. doi:10.1016/j.childyouth.2016.10.021

9. Bunting L, Davidson G, McCartan C, Hanratty J, Bywaters P, Mason W, Steils N. The association between child maltreatment and adult poverty - A systematic review of longitudinal research. Child Abuse Negl. 2018;77:121-133. doi:10.1016/j.chiabu.2017.12.022

10. Tanaka M, Jamieson E, Georgiades K, Duku EK, Boyle MH, MacMillan HL. The association between childhood abuse and labor force outcomes in young adults: Results from the Ontario child health study. J Aggress Maltreat Trauma. 2011;20(8):821-844. doi:10.1080/10926771.2011.621851

11. Fergusson DM, McLeod GFH, Horwood LJ. Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand. Child Abuse Negl. 2013;37(9):664-674. doi:10.1016/j.chiabu.2013.03.013

12. Strøm IF, Thoresen S, Wentzel-Larsen T, Hjemdal OK, Lien L, Dyb G. Exposure to life adversity in high school and later work participation: A longitudinal population-based study. J Adolesc. 2013;36(6):1143-1151. doi:10.1016/j.adolescence.2013.09.003

13. Baxter J, Taylor M. Socio-economic status of women across the life course in NSW. 2014. https://aifs.gov.au/publications/socio-economic-status-women-across-life-course-nsw

14. Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP. The effect of child sexual abuse on social, interpersonal and sexual function in adult life. Br J Psychiatry. 1994;165(1):35-47. doi:10.1192/bjp.165.1.35

15. Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP. The long-term impact of the physical, emotional, and sexual abuse of children: a community study. Child Abuse Negl. 1996;20(1):7-21. doi:10.1016/0145-2134(95)00112-3

16. Pereira P, Li L, Power C. Child maltreatment and adult living standards at 50 years. Pediatrics. 2017;139(1):e20161595. doi:10.1542/peds.2016-1595

17. Vergunst F, Tremblay RE, Nagin D, et al. Association between childhood behaviors and adult employment earnings in Canada. JAMA Psychiatry. 2019;76(10):1044-1051. doi:10.1001/jamapsychiatry.2019.1326

18. Kendall-Tackett KA, Williams LM, Finkelhor D. Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychol Bull. 1993;113(1):164-180. doi:10.1037/0033-2909.113.1.164

19. Chen LP, Murad MH, Paras ML, Colbenson KM, Sattler SL, Goranson EN, Elamin MB, Seime RJ, Shinozaki G, Prokop LJ, Zirakzadeh A. Sexual abuse and lifetime diagnosis of psychiatric disorders: Systematic review and meta-analysis. Mayo Clin Proc. 2010;85(7):618-629. doi:10.4065/mcp.2009.0583

20. McCloskey LA, Bailey JA. The intergenerational transmission of risk for child sexual abuse. J Interpers Violence. 2000;15(10):1019-1035. doi:10.1177/088626000015010001

21. Rouquette A, Côté SM, Pryor LE, Carbonneau R, Vitaro F, Tremblay RE. Cohort profile: The Quebec Longitudinal Study of Kindergarten Children (QLSKC). Int J Epidemiol. 2012;43(1):23-33. doi:10.1093/ije/dys177

22. Collet OA, Orri M, Tremblay RE, Boivin M, Côté SM. Psychometric properties of the Social Behavior Questionnaire (SBQ) in a longitudinal population-based sample. Int J Behav Dev. 2022:01650254221113472.

23. Tremblay RE, Loeber R, Gagnon C, Charlebois P, Larivée S, LeBlanc M. Disruptive boys with stable and unstable high fighting behavior patterns during junior elementary school. J Abnorm Child Psychol. 1991;19(3):285-300. doi:10.1007/bf00911232

24. Felitti VJ, Anda RF, Nordenberg D, Williamsom DF, Spitz AM, Edwards V, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245-58. doi:10.1016/s0749-3797(98)00017-8

25. Dube SR, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF. Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics. 2003;111(3):564-72. doi:10.1542/peds.111.3.564

26. Finkelhor D. Sexually victimized children. Free Press; 1979:xii, 228 p.

27. Findlay LC, Beasley E, Park J, Kohen D, Algan Y, Vitaro F, Tremblay RE. Longitudinal child data: What can be gained by linking administrative data and cohort data? Int J Popul Data Sci. 2018;3(1)/ doi: 10.23889/ijpds.v3i1.451

28. Hecht DB, Hansen DJ. The environment of child maltreatment: Contextual factors and the development of psychopathology. Aggress Violent Behav. 2001;6(5):433-457. doi:10.1016/S1359-1789(00)00015-X

29. Collin-Vézina D, Daigneault I, Hébert M. Lessons learned from child sexual abuse research: Prevalence, outcomes, and preventive strategies. Child Adolesc Psychiatry and Ment Health. 2013;7(1):22. doi:10.1186/1753-2000-7-22

30. Power C, Matthews S. Origins of health inequalities in a national population sample. Lancet. 1997;350(9091):1584-9. doi:10.1016/s0140-6736(97)07474-6

31. Azur MJ, Stuart EA, Frangakis C, Leaf PJ. Multiple imputation by chained equations: What is it and how does it work? Int J Methods in Psychiatr Res. 2011;20(1):40-9. doi:10.1002/mpr.329

32. Orri M, Vergunst F, Turecki G, Galera C, Latimer E, Bouchard S, Domond P, Vitaro F, Algan Y, Tremblay RE, Geoffroy MC, Côté SM. Long-term economic and social outcomes of youth suicide attempts. Br J Psychiatry. 2021:1-7. doi:10.1192/bjp.2021.133

33. Straus MA, Hamby SL, Finkelhor D, Moore DW, Runyan D. Identification of child maltreatment with the Parent-Child Conflict Tactics Scales: Development and psychometric data for a national sample of American parents. Child Abuse Negl.. 1998;22(4):249-70.

34. Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB. The revised conflict tactics scales (CTS2) development and preliminary psychometric data. J Fam Issues. 1996;17(3):283-316.

35. Barrett A, Kamiya Y, Sullivan VO. Childhood sexual abuse and later-life economic consequences. J Behav Exp Econ. 2014;53:10-16. doi:10.1016/j.socec.2014.07.001

36. Currie J, Widom CS. Long-term consequences of child abuse and neglect on adult economic well-being. Child Maltreat. 2010;15(2):111-120. doi:10.1177/1077559509355316

37. Assini-Meytin LC, Thorne EJ, Sanikommu M, Green KM, Letourneau EJ. Impact of child sexual abuse on socioeconomic attainment in adulthood. J Adolesc Health. 2022;doi:10.1016/j.jadohealth.2022.05.013

38. Henkhaus LE. The lasting consequences of childhood sexual abuse on human capital and economic well-being. Health Econ. 2022;31(9):1954-1972. doi:10.1002/hec.4557

39. Zielinski DS. Child maltreatment and adult socioeconomic well-being. Child Abuse Negl. 2009;33(10):666-78. doi:10.1016/j.chiabu.2009.09.001

40. Liu Y, Croft JB, Chapman DP, Perry GS, Greenlund KJ, Zhao G, Edwards VJ. Relationship between adverse childhood experiences and unemployment among adults from five U.S. states. Soc Psychiatry Psychiatr Epidemiol. 2013;48(3):357-369. doi:10.1007/s00127-012-0554-1

41. Brezo J, Paris J, Vitaro F, Hebert M, Tremblay RE, Turecki G. Predicting suicide attempts in young adults with histories of childhood abuse. Br J Psychiatry. 2008;193(2):134-139. doi:10.1192/bjp.bp.107.037994

42. Ammerman RT. Methodological Issues in Child Maltreatment Research. In: Lutzker JR, ed. Handbook of Child Abuse Research and Treatment. Springer US; 1998:117-132.

43. Dong M, Anda RF, Dube SR, Giles WH, Felitti VJ. The relationship of exposure to childhood sexual abuse to other forms of abuse, neglect, and household dysfunction during childhood. Child Abuse Negl. 2003;27(6):625-639. doi:10.1016/S0145-2134(03)00105-4

44. Geoffroy MC, Pinto Pereira S, Li L, Power C. Child neglect and maltreatment and childhood-to-adulthood cognition and mental health in a prospective birth cohort. J Am Acad Child Adolesc Psychiatry. 2016;55(1):33-40.e3. doi:10.1016/j.jaac.2015.10.012

45. Nelson EC, Heath AC, Madden PA, Cooper L, Dinwiddie SH, Bucholz KK, Glowinski A, McLaughlin T, Dunne MP, Statham DJ, Martin NG. Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: Results from a twin study. Arch Gen Psychiatry. 2002;59(2):139-145. doi:10.1001/archpsyc.59.2.139

46. Felitti VJ. Long-term medical consequences of incest, rape, and molestation. South Med J. 1991;84(3):328-331. doi:10.1097/00007611-199103000-00008

47. Putnam FW. Ten-year research update review: Child sexual abuse. J Am Acad Child Adolesc Psychiatry. 2003;42(3):269-278. doi:10.1097/00004583-200303000-00006

48. Cougle JR, Timpano KR, Sachs-Ericsson N, Keough ME, Riccardi CJ. Examining the unique relationships between anxiety disorders and childhood physical and sexual abuse in the National Comorbidity Survey-Replication. Psychiatry Res. 2010;177(1-2):150-155. doi:10.1016/j.psychres.2009.03.008

49. Henry KL, Fulco CJ, Merrick MT. The harmful effect of child maltreatment on economic outcomes in adulthood. Am J Public Health. 2018;108(9):1134-1141. doi:10.2105/ajph.2018.304635

50. Hardt J, Rutter M. Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. J Child Psychol Psychiatry. 2004;45(2):260-273. doi:10.1111/j.1469-7610.2004.00218.x

51. Gotlib IH, Joormann J. Cognition and depression: current status and future directions. Annu Rev Clin Psychol. 2010;6:285-312. doi:10.1146/annurev.clinpsy.121208.131305

52. Kendall-Tackett KA, Becker-Blease K. The importance of retrospective findings in child maltreatment research. Child Abuse Negl. 2004;28(7):723-7. doi:10.1016/j.chiabu.2004.02.002

53. Guralnik JM, Kaplan GA. Predictors of healthy aging: Prospective evidence from the Alameda County study. Am J Public Health. 1989;79(6):703-708.

54. Marmot M. The influence of income on health: views of an epidemiologist. Health Aff. 2002;21(2):31-46. doi:10.1377/hlthaff.21.2.31

55. MacMillan HL, Tanaka M, Duku E, Vaillancourt T, Boyle MH. Child physical and sexual abuse in a community sample of young adults: Results from the Ontario Child Health Study. Child Abuse Negl. 2013;37(1):14-21. doi:10.1016/j.chiabu.2012.06.005

FIGURES

Figure 1. Employment earnings from ages 18 to 37 years, by presence or lack of sexual abuse (N = 3020).

Note. In accordance with Statistics Canada data protection requirements, displayed counts are rounded to base 10; employment earnings are rounded to the nearest 100. Dollar amounts have not been adjusted for inflation.

Figure 2. Employment earnings from ages 18 to 37 years, by sexual abuse characteristics (n = 350).

1. Type of abuse

2. Severity of abuse

C. Chronicity of abuse

Note. In accordance with Statistics Canada data protection requirements, displayed counts are rounded to base 10; employment earnings are rounded to the nearest 100. Dollar amounts have not been adjusted for inflation.

TABLES

Table 1. Association of child sexual abuse with annual employment earnings at mid-adulthood (33-37 years).

Note. Boldface indicates statistical significance (P < 0.05).

Reference category = no abuse.

^a Based on imputed values. All amounts are in US dollars. Dollar amounts have not been adjusted for inflation.

^b Estimates are beta coefficients from Tobit regression, with 95% confidence intervals. All three models were adjusted for cohort membership (disruptive vs. representative sample).

^c Adjusted for characteristics including child’s sex, maternal and paternal education, parental earnings, parental mean age at childbirth, and family unit (single- or two-parent family).

Table 2. Association of characteristics of child sexual abuse with annual employment earnings at mid-adulthood (33-37 years)

Note. Boldface indicates statistical significance (P < 0.05).

^a Based on imputed values. All amounts are in US dollars. Dollar amounts have not been adjusted for inflation.

^b Estimates are beta coefficients from Tobit regression, with 95% confidence intervals. All three models were adjusted for cohort membership (disruptive vs. representative sample).

^c Adjusted for characteristics including child’s sex, maternal and paternal education, parental earnings, parental mean age at childbirth, and family unit (single- or two-parent family).

APPENDIX

Appendix Table 1. Prevalence and characteristics of child sexual abuse.

Note. In accordance with Statistics Canada data protection requirements, displayed counts are rounded to base 10.

Appendix Table 2. Child sexual abuse group and socioeconomic characteristics in childhood and mid-adulthood (33-37 years).

Note. Based on total sample N = 3020 (n = 2136 to 2998).

^a In accordance with Statistics Canada data protection requirements, displayed counts are rounded to base 10.

^b Boldface indicates statistical significance (P < 0.05).

^c Rounded to the nearest $100, as per Statistics Canada data protection regulations. Dollar amounts have not been adjusted for inflation.

Appendix Table 3. Characteristics of child sexual abuse and socioeconomic characteristics in childhood and mid-adulthood (33-37 years).

Note. Based on participants with retrospectively self-reported abuse (n = 260 to 350).

^a In accordance with Statistics Canada data protection requirements, displayed counts are rounded to base 10.

^b Boldface indicates statistical significance (P < 0.05).

^c Rounded to the nearest $100, as per Statistics Canada data protection regulations. Dollar amounts have not been adjusted for inflation.

Appendix Table 4. Associations of child sexual abuse with annual employment earnings at mid-adulthood (33-37 years), using non-imputed values.

Note. Boldface indicates statistical significance (P < 0.05).

Reference category = no abuse.

^a Based on non-imputed values. All amounts are in US dollars. Dollar amounts have not been adjusted for inflation.

^b Estimates are beta coefficients from Tobit regression, with 95% confidence intervals. All three models were adjusted for cohort membership (disruptive vs. representative sample).

^c Adjusted for characteristics including child’s sex, maternal and paternal education, parental earnings, parental mean age at childbirth, and family unit (single- or two-parent family).

Appendix Table 5. Associations of characteristics of child sexual abuse with employment earnings at mid-adulthood (33-37 years), using non-imputed values.

Note. Bold face indicates statistical significance (P < 0.05).

^a Based on non-imputed values. All amounts are in US dollars. Dollar amounts have not been adjusted for inflation.

^b Estimates are beta coefficients from Tobit regression, with 95% confidence intervals. All three models were adjusted for cohort membership (disruptive vs. representative sample).

^c Adjusted for characteristics including child’s sex, maternal and paternal education, parental earnings, parental mean age at childbirth, and family unit (single- or two-parent family).

Appendix Table 6. Association of child sexual abuse with employment earnings at mid-adulthood (33-37 years), excluding individuals missing on the retrospective questionnaire.

Note. Boldface indicates statistical significance (P < 0.05).

Reference category = no abuse.

^a Based on imputed values. All amounts are in US dollars. Dollar amounts have not been adjusted for inflation.

^b Estimates are beta coefficients from Tobit regression, with 95% confidence intervals. Models were adjusted for cohort membership (disruptive vs. representative sample).

^c Adjusted for characteristics including child’s sex, maternal and paternal education, parental earnings, parental mean age at childbirth, and family unit (single- or two-parent family).

Appendix Table 7. Association of characteristics of child sexual abuse with employment earnings at mid-adulthood (33-37 years), by sex.

Note. Boldface indicates statistical significance (P < 0.05).

^a Based on imputed values. All amounts are in US dollars. Dollar amounts have not been adjusted for inflation.

^b Estimates are beta coefficients from Tobit regression, with 95% confidence intervals. Models were adjusted for cohort membership (disruptive vs. representative sample).

^c Adjusted for characteristics including, maternal and paternal education, parental earnings, parental mean age at childbirth, and family unit (single- or two-parent family).

Appendix Table 8. Associations of child sexual abuse with employment earnings at mid-adulthood (33-37 years), controlling for physical abuse.

Note. Boldface indicates statistical significance (P < 0.05).

Reference category = no abuse.

^a Based on imputed values. All amounts are in US dollars. Dollar amounts have not been adjusted for inflation.

^b Estimates are beta coefficients from Tobit regression, with 95% confidence intervals. Models were adjusted for cohort subset (disruptive vs. representative sample).

^c Adjusted for characteristics including child’s sex, maternal and paternal education, parental earnings, parental mean age at childbirth, and family unit (single- or two-parent family), and retrospective reports of physical abuse.

Appendix Table 9. Associations of the characteristics of retrospectively reported child sexual with adult employment earnings at mid-adulthood (33-37 years), controlling for physical abuse.

Note. Bold face indicates statistical significance (P < 0.05).

^a Based on non-imputed values. All amounts are in US dollars. Dollar amounts have not been adjusted for inflation.

^b Estimates are beta coefficients from Tobit regression, with 95% confidence intervals. Models were adjusted for cohort membership (disruptive vs. representative sample).

^c Adjusted for characteristics including child’s sex, maternal and paternal education, parental earnings, parental mean age at childbirth, and family unit (single- or two-parent family) and retrospective reports of physical abuse.