Mental health sequelae following child sexual abuse managed at “Lamapiyasa” in Colombo North Teaching Hospital, Ragama, Sri Lanka

Abstract

Background: Childhood sexual abuse (CSA) is a profoundly traumatic experience that can result in lasting psychological consequences. This study was conducted to assess the prevalence of psychological consequences among CSA survivors and to assess the associations between abuse related factors and subsequent psychological consequences. Method: A retrospective descriptive study on 448 cases of CSA (0–18 years) managed at “Lamapiyasa”, Colombo North Teaching Hospital, Ragama, Sri Lanka from 2015 to 2022. Data was extracted from case files and Bed-Head Tickets using a standardized proforma, with the mental disorder diagnoses established according to accepted psychiatric criteria. Comparative analysis was performed using SPSS version 26. Results: About 15.8% (n=71) of children were diagnosed with at least one psychological consequence, comprising post-traumatic stress disorder (4.9%; n=22), anxiety/acute stress disorder (3.13%; n=14), depression (4%; n=18), hypersexual behaviour (5.13%; n=23) and phobia (0.22%; n=1) with some children receiving multiple diagnoses. There was no significant association between the victim’s age and the presence of psychological consequences. Notably, a larger victim–perpetrator age gap (exceeding three years) nearly doubled the risk of having psychological consequences, with 16.86% (n=30) for a 3–10-year gap and 16.41% (n=32) for gaps >10 years compared to 8.57% (n=3) for gaps <3 years. Children presenting with neurodevelopmental challenges, specifically disabilities, low IQ, or learning disorders were significantly less likely to be diagnosed to have psychological consequences (P=0.021). No significant differences in the presence of psychological consequences were observed between penetrative (15.38%) and non-penetrative abuse (16.25%; P=0.9) or across perpetrator types (boyfriends 18.86%, incest 16.66%, neighbours 10.2%, strangers 18.5%; P=0.4). Conclusion: A pronounced victim–perpetrator age gap (>3 years) emerged as a pivotal factor, nearly doubling the risk of prevalence of psychological consequences. In contrast, the unexpectedly lower diagnostic rates observed in children with neurodevelopmental challenges raise critical questions about symptom recognition and diagnostic practices in this subgroup emphasizing the need for more effective clinical strategies and policymaking for vulnerable populations.