Posttraumatic growth in child sexual abuse survivors: a scoping review protocol

doi:10.21203/rs.3.rs-2084346/v1

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Posttraumatic growth in child sexual abuse survivors: a scoping review protocol

https://doi.org/10.21203/rs.3.rs-2084346/v1

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Background: Child sexual abuse (CSA) is a severe type of victimization that implies prolonged and devastating traumatization. However, some research suggests that CSA survivors can also experience personal and deep transformation in the aftermath of struggling with the pain and distress derived from the abuse experience, referred to as posttraumatic growth (PTG). This change in terms of beliefs, attitudes and values is self-perceived and improves subjective well-being. The aim of this scoping review is to compile studies about PTG experienced by CSA survivors, offering a wide overview of the main methodologies and findings, and identifying areas for further research on this topic. Method: The review will follow the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) and the five-step process described by Arksey and O’Malley. The databases selected for the search were: Web of Science, Scopus, PsycInfo, Medline and ProQuest Social Science. Only peer-review studies will be considered for this review, covering qualitative and quantitative methodologies. Studies about PTG in adult CSA survivors will be included in the review. Screening of the studies will be performed independently by two researchers, reading titles and abstracts from all potentially relevant studies. Any possible conflict will be resolved by a third reviewer before the full-text review. After that, two reviewers will complete the data extraction with a tailored data extraction tool. Descriptive and narrative analysis will be performed to show the results of the scoping review.

Discussion: Ethical approval is not required. The results will be disseminated through a peer-reviewed article and conference presentations.

posttraumatic growth

child sexual abuse

scoping review

Child sexual abuse (CSA) is a severe type of child victimization that violates both the dignity and sexual rights and freedom of children and adolescents and constitutes a serious public health and social problem (1). Its prevalence is high and affects around 7.6% men and 31.0% women around the world (2-4). CSA has devastating lifetime consequences for survivors, greatly increasing the risk of emotional difficulties, lack of self-esteem and trust in oneself, others and life, social isolation, psychological and psychosocial maladjustment, lower job stability and fewer job opportunities, more physical health problems, and multiple psychiatric diagnoses in their lifetime (5-8). Furthermore, Walker et al. (9) reported that more than half of victims experience lifetime revictimization, which implies devastating barriers due to the repeated experiences of violence.

The existing knowledge on the sequelae of CSA is highly relevant for designing ways to promote reparation and healing processes in survivors (10). Nevertheless, during the last two decades another perspective has also gained the attention of researchers (11). Thus, in addition to the negative effects linked to sexual abuse, other psychological processes and changes related to personal growth can follow on from the trauma experienced by CSA survivors, such as learning, strengthening and self-regulation, which could help to improve well-being (12-14).

The study of personal growth and the human transformative aftermath of trauma has its origin in psychosocial, constructivist and humanistic approaches (15). Tedeschi and Calhoun (16) proposed the term posttraumatic growth (PTG) to refer to the process of experiencing psychological changes regarding values, meaning and sense of life after a traumatic experience. This process differs from that of natural developmental personal growth and stems from the processes needed to rebuild the internal assumptive world that was ruptured by the trauma (11). PTG is a deep and internal process that implies emotional, cognitive and attitudinal changes that are not only conscious and self-perceived but also valued as positive outcomes (17,18) and result in psychological well-being (19-21).

The relationship between suffering derived from traumatic experiences and PTG has been demonstrated (22,23), and has been addressed in a wide variety of populations affected by a diversity of traumatic experiences among countries from all over the world: cancer survivors (24), people with threatening physical illness (25), veterans of war and military service (26), refugees (27), bereavement survivors (28), and natural disaster survivors (29), among others.

PTG has also been a focus of interest in the interpersonal violence field, although it has been less frequently studied. A recent systematic review (30) summarized the rates and characteristics of PTG in survivors of interpersonal violence in adulthood, including intimate partner violence, sexual assault, rape, and physical assault. Others have explored and assessed PTG in adult victims of childhood maltreatment such as physical abuse, sexual abuse, emotional abuse, neglect and institutional abuse (31-36). Recently, systematic and scoping reviews have been published about the contexts and circumstances of PTG experienced by sexually victimized women (37) as well as meaning-making processes observed in women that had experienced CSA (38).

Study rationale

The scientific community is turning more and more attention to the study of PTG in CSA survivors and its relation with the meaning-making, processing, and healing following abuse. The trauma derived from CSA has some particular characteristics that set it apart from other types of trauma: it is experienced during childhood, a life period where the meaning of the world and one’s own identity is under construction; it is usually related to silence and secrets (39), and the difficulties of disclosure stave off the verbalization and externalization of the pain resulting from the trauma; it also tends to be a chronic experience that the victim suffers for a long period of time in isolation (40), which implies that it is not only a static turning point in the life of the victim, but more of a process that often leads the survivors to present serious psychological, emotional and social sequelae throughout their lifetime. Thus, CSA is a very particular and complex victimization experience as a subjective lived event as well as a social phenomenon.

Due to the complexity and sensitivity of the topic and in order to achieve different objectives such as building generalizable and deep knowledge with scientific rigor, and addressing important ethical issues, it has been necessary to carry out different approaches and use different research designs in terms of both methodology (from the qualitative and the quantitative to mixed methods), as well as the variables or study topics that may be explanatory or that help understand the PTG phenomenon in CSA survivors.

Thus, we intend to conduct a scoping review of a large set of studies with a wide range of designs in order to offer an overview of the subject of study (41).

Study objectives

The principal aim of this review is to offer a neat and exhaustive compilation of all the peer-reviewed studies about PTG experienced by CSA survivors, to explain which variables and topics have been studied and with which methodologies, and which measures have been addressed. The review will provide an overview of the main findings and will serve as a guide to academics that want to conduct research on this phenomenon, as well as suggesting areas for future investigation that will allow application of the knowledge gained to CSA intervention.

In response to the needs and limitations mentioned previously, we consider that a scoping review is a better option than a systematic review to ensure coverage of the body of literature on our topic and our study objectives (42).

The present review will follow the PRISMA methodology to ensure rigor and reduce bias in the review process. Specifically, this work will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) described by Tricco et al. (43). The review process will include five stages: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing, and reporting the results, as briefly described in the current protocol.

Stage 1. Identifying the research questions

According to Arksey and O’Malley, the research team will use an iterative process to formulate a broad research question that will focus on the PTG experiences in adult survivors of CSA (44). To build a clear research question and answer it we will define the main concepts, the target population and outcomes of interest for the scoping review (41). The initial research question that will guide our scoping study is as follows: Which variables, individual lived events, contexts, meaning-making and personal processes are related to the development of PTG experienced by CSA adult survivors and which methodologies have been used to study this topic? This question will guide the process of identification and exploration of information of interest for the scoping review presented in studies that demonstrate rigorous knowledge about this topic.

Stage 2. Identifying relevant studies

A comprehensive search will be performed in the following databases: Web of Science, Scopus, PsycInfo, Medline, and ProQuest Social Science. These databases cover a wide range of disciplines and topics related to posttraumatic growth, trauma, child abuse or neglect in child and adolescent populations. The Boolean operators used to build the keyword searches will be “AND” and “OR”. The following keywords will be used to perform the search: “growth”, “healing”, “abuse”, “victim”, “trauma”, “survivor”, “child”, “adolescent”, “youth”, “young” and “minor”. The syntax created with the keywords selected will follow an iterative process (41), redefining the search terms of previous searches to ensure that all the important literature is covered in a comprehensive way (44). The final syntaxes already in all databases are shown in Table 1. The review will be performed between May and December 2022.

insert Table 1 about here

Regarding the type of studies, this review will include scientific peer-reviewed studies, either found in databases or in references in scientific articles. All empirical research approaches and study designs will potentially be included in this work, including randomized and non-randomized controlled or clinical trials, cluster trials, controlled before-after studies, prospective and retrospective comparative cohort studies, longitudinal studies, study cases, qualitative studies, etc. The search will be limited by year of publication, considering only papers published from 1995 onwards, coinciding with the introduction of the concept of posttraumatic growth in the scientific literature. Concerning the language, studies in English, Spanish, Italian, Portuguese, French and German will be considered for this review. The population for this review will include studies conducted with adult participants who suffered sexual abuse during their childhood. There are no cultural or geographic limitations for the studies included in this review.

Stage 3. Study selection

Following the PRISMA-ScR method, a flow chart (45) will be used to record the selection process for this review. First, all the results obtained from the databases will be downloaded into EndNote online software (Clarivate Analytics) to remove the duplicate records. After that, all the results will be uploaded in the Rayyan online software platform (Qatar Computing Research Institute), which will be used for the selection process (46). A final check for duplicates will be performed manually in Rayyan.

Second, screening will be performed independently by two researchers, reading titles and abstracts from all the potentially relevant studies included in the final Rayyan database. Selection of studies for inclusion will be carried out considering the above-mentioned inclusion criteria, which have been established by consensus among the researchers.

After that, a full-text review will be performed to determine whether identified studies will be included or not. At this point, the references of the included articles will be reviewed to consider other possible relevant studies in the field. Consequently, the selection process will be repeated with those studies, to include or exclude them from the review. Any disagreements between selectors will be resolved by a third researcher who will decide whether the study should be included in the review.

Stage 4. Charting the data

The next stage will involve the extraction of data from all eligible studies. A data extraction tool has been developed (41), involving four categories of information from the documents. Table 2 shows the information and variables that will be extracted from each study selected for the scoping review.

insert Table 2 about here

Following the iterative search methodology (41,44), this extraction form will be tested in 10% of the studies selected, to demonstrate that the application of the tool by reviewers is consistent. Any possible disagreement will be resolved by discussion and consensus among reviewers. If the application of this tool encounters any problems, the instrument will be revised and modified to improve the data extraction process. After this test, two reviewers will extract the information independently from each study included in the scoping review. Any discrepancy will be resolved by consensus between reviewers. Supervision by a third reviewer will be introduced if no consensus is achieved, in order to make a final decision.

Stage 5. Collating, summarizing, and reporting the results

Data will be analyzed and summarized descriptively, presenting the main characteristics of the studies included in the scoping review as suggested by Arksey and O’Malley (44). The variables analyzed will include: authorship, year, country, sample size, sex distribution, age, variables measured, instruments used and data collection techniques. Most of this information will be presented in a summary table, for easy identification of the study characteristics.

In order to present a narrative account of the existing literature, an analytic framework or thematic construction will be performed (44). A narrative summary of the thematic analysis will be presented in the results section.

Finally, the descriptive and narrative analytics will highlight gaps in existing research evidence, providing guidelines for future research about posttraumatic growth in victims of childhood sexual abuse. At the same time, the implications of this topic for research, practice, and policy contexts will be discussed (41).

Ethics and dissemination

This study will be the first scoping review to focus on the specific construct of PTG in adult survivors of CSA, and will include studies of all kinds of methodologies, and samples that comprise both male and female survivors. The results obtained will be a useful guide for continuing building knowledge and facilitating proposals and discussion among researchers, as well as professionals that specifically work on PTG related to CSA.

This protocol for the scoping review, based on a comprehensive and standardized methodology, does not require ethical approval or consent to participate or publicate, since the review process involves collecting and categorizing public materials.

The results of the scoping review will be disseminated through articles submitted for publication to a peer-reviewed academic journal and communications at relevant conferences.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Funding

The first author holds a predoctoral contract (blinded for review), funded by [blinded for review] through the Agency for the Management of University and Research Grants (AGAUR) from the Government of Catalonia. The second author holds a Margarita Salas postdoctoral contract (blinded for reiew) funded by the [blinded for review] through the Program for Requalification of the Spanish University System.

Competing interest statement

The authors declare no competing interests.

Authors' contributions

All the authors designed the study and the first search strategy. LS developed the theoretical framework including background, study rationale, objectives, and conclusions of the first draft of the manuscript. AA-O developed the methodological framework of the first draft of the manuscript. MB and NP reviewed and provided regular feedback of the manuscript, guided theoretical and methodological framework, and contributed to a critical revision of the final manuscript. All authors have read and approved the manuscript.

Acknowledgment

We thank the Ministerio de Economía, Industria y Competitividad.

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Table 1. Search teams for each data base

Data base	Syntaxes
Web of Science	(TS=(growth) OR TS=(healing)) AND TS=(sex) AND (TS=(abuse) OR TS=(victim) OR TS=(trauma) OR TS=(survivor)) AND (TS=(child) OR TS=(adolescen) OR TS=(youth) OR TS=(young) OR TS=(minor))
Scopus	(TITLE-ABS-KEY (growth) OR TITLE-ABS-KEY (healing)) AND TITLE-ABS-KEY (sex) AND (TITLE-ABS-KEY (abuse) OR TITLE-ABS-KEY (victim) OR TITLE-ABS-KEY (trauma) OR TITLE-ABS-KEY (survivor)) AND (TITLE-ABS-KEY (child) OR TITLE-ABS-KEY (adolescen) OR TITLE-ABS-KEY (youth) OR TITLE-ABS-KEY (young) OR TITLE-ABS-KEY (minor))
PsycInfo	(if(sex) AND (if(child) OR if(adolescen) OR if(youth) OR if(young) OR if(minor)) AND (if(abuse) OR if(victim) OR if(trauma) OR if(survivor)) AND (if(growth) OR if(healing))) OR ((ab(child) OR ab(adolescen) OR ab(youth) OR ab(young) OR ab(minor)) AND (ab(growth) OR ab(healing)) AND ab(sex) AND (ab(abuse) OR ab(victim) OR ab(trauma) OR ab(survivor))) OR ((ti(growth) OR ti(healing)) AND ti(sex) AND (ti(abuse) OR ti(victim) OR ti(trauma) OR ti(survivor)) AND (ti(child) OR ti(adolescen) OR ti(youth) OR ti(young) OR ti(minor)))
Social Science ProQuest	(ti(growth OR healing) AND ti(sex) AND ti(abuse OR victim OR trauma OR survivor) AND ti(child* OR adolescen* OR young OR youth OR minor)) OR (ab(growth OR healing) AND ab(sex) AND ab(abuse OR victim OR trauma OR survivor) AND ab(child* OR adolescen* OR young OR youth OR minor)) OR (if(growth OR healing ) AND if(sex) AND if(abuse OR victim OR trauma OR survivor) AND if(child* OR adolescen* OR young OR youth OR minor))
Medline	(ti(growth OR healing) AND ti(sex) AND ti(abuse OR victim OR trauma OR survivor) AND ti(child* OR adolescen* OR young OR youth OR minor)) OR (ab(growth OR healing) AND ab(sex) AND ab(abuse OR victim OR trauma OR survivor) AND ab(child* OR adolescen* OR young OR youth OR minor)) OR (if(growth OR healing ) AND if(sex) AND if(abuse OR victim OR trauma OR survivor) AND if(child* OR adolescen* OR young OR youth OR minor))

Table 2. Data extraction tool

Category	Variable	Information extracted
Descriptive document’ characteristics	Type of document	Peer-reviewed studies.
	Year	Year of publication.
	Authors	Authorship of the document.
	Title	Title of the document.
	Language	Language of publication.
Study characteristics	Objective	Main objective(s) of the study.
	Study design	Randomized controlled trial, non-randomized controlled trial, pretest-posttest design, qualitative design, mixed methods, or other design.
	Sample size	Number of participants.
	Country	Country or countries where the sample was collected.
	Data collection technique	Interviews, surveys or standardized questionnaires, focal groups, discussion groups, etc.
	Instrument(s)	Assessment instruments used in the study.
	Data analytics	Techniques used to analyze the data obtained in the study.
	Variables measured	Constructs and variables assessed or collected as data.
Participant characteristics	Sex	Number or percentage of each sex/gender group (depending on the variable measure in each study).
	Age	Age of participants, reported by mean and standard deviation or age ranges.
	Ethnicity	Number or percentage of each ethnic origin.
	Education	Number of years of education or educational level.
	Control group	Distribution of participants in groups or use of comparison group.
	Types of victimization and/or abuse	Types of victimization and/or abuse suffered by the participants.
	Type of child sexual abuse	Specifically, type of child sexual abuse suffered during childhood.
	Age of abuse	Age or range of years when children suffered child sexual abuse.
	Therapy	Record of therapy assistance during lifetime of participants.
	Psychosocial difficulties	Existence of psychosocial difficulties (such as drug use, mental health problems, poverty, disability, gender violence, suicide behavior, criminal behavior, unemployment, etc.)
Conclusions	Outcomes or conclusions	Main identified outcomes or conclusions from the study.

No competing interests reported.

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Posttraumatic growth in child sexual abuse survivors: a scoping review protocol

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