The association between child sexual abuse and mental health in Chinese vocational high school students

To explore the associations between verbal/visual and physical child sexual abuse (CSA) and mental health outcomes among vocational high school students (VHSS), who are at-risk populations of CSA and have mental health problems. A cross-sectional study using cluster sampling was conducted from April to June 2021 in China. Data were collected from VHSS using an anonymous self-administered online questionnaire. A five-item scale was used to measure different forms of CSA ranged from unwanted sexual harassment to forced sexual intercourse by adults before the age of 18. Mental health was assessed using the patient health questionnaire for depression and anxiety (PHQ-4), as well as two single-item questions to assess self- injury ideation and suicide ideation. A total of 3180 participants (49.0% male), with a mean age of 16.9 ± 1.3 years. Approximately 24.7% of male and 14.4% of female VHSS had experienced at least one form of CSA (p < 0.001). Physical CSA was associated with an increased risk of anxiety symptoms (OR = 2.21, 95% CI 1.40-3.50), self-injury ideation (OR 2.01, 95% CI 1.05-3.83) and suicide ideation (OR = 2.90, 95% CI 1.31-6.40) in boys, and anxiety symptoms (OR 1.69, 95% CI 1.05-2.71) and depressive symptoms (OR 1.75, 95% CI 1.23-2.50) in girls. Verbal/visual CSA was associated with an increased risk of self-injury ideation (OR 1.67, 95% CI 1.17-2.38) in girls only. Boy reported higher prevalence of CSA than girls. Physical CSA and mental health problems are significantly associated with some gender difference. It is imperative to take comprehensive strategies to address the challenges related to CSA, with particular attention to the needs of boys.