Background: Adverse childhood experiences including childhood sexual abuse (CSA), have been widely recognized as significant risk factors for long-term mental health challenges. Female survivors of CSA are particularly vulnerable for poor mental health outcomes such as depression, anxiety, and post-traumatic stress disorder. Social determinants can either exacerbate or mitigate the mental health impacts of ongoing childhood trauma. However, less is known about the impact of social determinants of health (SDOH) on the mental health among the female CSA survivors. This study examines the associations between SDOH and poor mental health among female CSA survivors.
Methods: Data of 4,840 adult female CSA survivors were examined from the 2022 Behavioral Risk Factor Surveillance System. The outcome variable was the number of days of poor mental health in the past month (zero day, 1-13days, ≥14 days). Mental health includes stress, depression, and emotional problems. The included SDOH were sociodemographic characteristics (age, education, race, income, marital status, place of residency), receipt of social and emotional support in the past 12 months, perceived social isolation in the past 12 months, and housing insecurity (defined as inability to pay mortgage, rent or utility bills) in the past 12 months. Descriptive, bivariate, and multinomial logistic regression analyses were performed to examine the association between SDOH and mental health using Stata 18.0.
Results: In 2022, 60% (n = 2,895) of US female survivors of CSA reported experiencing at least one day of poor mental health, with approximately 28% (n =1,344) indicating that they had experienced frequent mental distress (defined as ≥14 days mentally unhealthy days) in the past month. The multinominal logistic regression results showed that the higher risk of experiencing more days of mental health distress was observed among female CSA survivors who were socially isolated (Relative Risk Ratio (RRR) = 4.59, P<0.001) and those unable to pay mortgage, rent, or utilities (RRR = 2.85, P = 0.003) Women who received social and emotional support have lower risk of poor mental health ≥14 days (RRR=2.85, P=0.003).
Conclusion. Findings suggest that SDOH impacts the mental health of female CSA survivors. Results reinforce the need for services and research to meet the social-emotional demands and ways to overcome social isolation of these survivors and provide resources to bolster their financial security.