Victims of child sexual abuse in Singapore present to ED only after >1 incident: study

Child sexual abuse (CSA) poses a serious problem in Singapore, wherein girls aged <13 years are often abused by a family member in their own home, reveals a study. Moreover, several victims present to the paediatric emergency department (ED) only after a repeated incident.

“We found that many children presented after more than one incident of abuse, suggesting that potentially at-risk children require closer surveillance by parents, schools, and support organizations and that they should be provided with more opportunities for disclosure,” the researchers said.

“Understanding the characteristics associated with CSA will enable vulnerable groups of children to be identified and protected, for example by training them to recognize and avoid situations that may lead to sexual abuse,” they added.

A retrospective review was carried out on CSA victims aged 0–16 years presenting to KK Women’s and Children’s Hospital ED from June 2016 to August 2020. The researchers also conducted a secondary analysis on girls and stratified them by age <13 and ≥13 years old.

A total of 790 patients made 833 visits for CSA. Majority of the victims were girls (n=747, 94.8 percent), and perpetrators were predominantly men (n=763, 96.6 percent). The first episode of abuse occurred before the age of 13 years in 315 victims (39.9 percent). More than one incident occurred before presentation for 468 victims (59.2 percent). [Ann Acad Med Singap 2021;50:527-535]

Girls aged <13 years, compared to those aged ≥13 years, were more frequently abused by a family member (47.7 percent vs 8.0 percent; p<0.001) and abused in their own home (55.7 percent vs 21.0 percent; p<0.001).

Parental divorce and the absence of one or both biological parents in the household were common among all victims, with 287/783 (36.7 percent) having divorced parents, and only 374/784 (47.8 percent) residing with both biological parents.

“Our study showed that CSA is a major problem in Singapore, with 39.9 percent of the victims … having been abused before they were 13 years old,” the researchers said. “Similar to worldwide studies, most of the victims were girls and most of the perpetrators were men.” [Child Maltreat 2011;16:79-101; Int J Public Health 2013;58:469-483; Child Adolesc Psychiatr Clin N Am 2014;23:321-337]

On the other hand, the number of victims who were boys (n=43, 5.4 percent) was lower than global reports and other Asian countries such as South Korea, China, and Taiwan. [Child Abuse Negl 2011;35:1037-1044; J Child Sex Abus 2018;27:107-121; Child Abuse Negl 2016;52:169-176]

“There are reports that boys are more reluctant to disclose CSA,” the researchers said. “Reasons that have been postulated include boys fearing not being recognized as a victim, being perceived as less masculine, or being labelled homosexual.” [J Child Sex Abus 2016; 25:221-241; Child Abuse Negl 2018;79:183-191; Child Abuse Negl 2019;88:455-465]

“It is unclear whether the low proportion of boys in our study is due to a true lower prevalence or a lower rate of disclosure,” they added.

Further research is warranted to determine barriers to disclosure in Singapore’s cultural context, according to the researchers, noting that efforts must be taken to encourage prompt discovery before recurrent events can occur.

“This could include training parents and teachers on effective questioning of children about possible CSA, providing more opportunities for children to disclose, and providing avenues for friends of victims, particularly adolescent victims, to disclose,” they said. [Child Abuse Negl 2004;28:147-165; J Child Sex Abus 2018;27:176-194; Child Abuse Negl 2008;32:1095-1108]