Childhood Sexual Trauma and Subjective Cognitive Decline: An Assessment of Racial/Ethnic and Sexual Orientation Disparities

Abstract

Prior studies examining the association between childhood sexual abuse (CSA) and subjective cognitive decline (SCD) are limited. The aim of this study was to examine the racial/ethnic and sexual orientation disparities in the association between CSA and SCD. Using data from the 2019 Behavioral Risk Factor Surveillance System Survey, crude and multivariable logistic regression models were used to determine the association between CSA and SCD adjusting for sociodemographic characteristics, diabetes, hypertension, and depression. There were statistically significant differences in CSA status by age, gender, income, education, employment, and health status (depression). Black and Hispanic/Latine respondents had a stronger relationship between CSA and SCD compared to White populations. Also, sexual minority populations had a stronger relationship between CSA and SCD compared to heterosexual populations. Health disparities exist in the association between CSA and SCD. Trauma-informed interventions should be implemented among affected populations.

Keywords

childhood sexual abuse disparities race/ethnicity sexual orientation cognition

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References

American College of Obstetricians and Gynecologists (ACOG) . (2022). Adult manifestations of childhood sexual abuse. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2011/08/adult-manifestations-of-childhood-sexual-abuse

American Psychiatric Association . (2023). What is Depression? https://www.psychiatry.org/patients-families/depression/what-is-depression

Amodeo

Griffin

M. L.

Fassler

I. R.

Clay

C. M.

Ellis

M. A.

(2006). Childhood sexual abuse among black women and white women from two-parent families. Child Maltreatment, 11(3), 237–246. https://doi.org/10.1177/1077559506289186

Andersen

J. P.

Blosnich

(2013). Disparities in adverse childhood experiences among sexual minority and heterosexual adults: Results from a multi-state probability-based sample. PLoS One, 8(1), Article e54691. https://doi.org/10.1371/journal.pone.0054691

Arreola

S. G.

Neilands

T. B.

Pollack

L. M.

Paul

J. P.

Catania

J. A.

(2005). Higher prevalence of childhood sexual abuse among Latino men who have sex with men than non-latino men who have sex with men: Data from the urban men’s health study. Child Abuse and Neglect, 29(3), 285–290. https://doi.org/10.1016/j.chiabu.2004.09.003

Arroyo

J. A.

Simpson

T. L.

Aragon

A. S.

(1997). Childhood sexual abuse among hispanic and non-hispanic white college women. Hispanic Journal of Behavioral Sciences, 19(1), 57–68. https://doi.org/10.1177/07399863970191004

Baiden

Cassidy

Panisch

L. S.

LaBrenz

C. A.

Onyeaka

H. K.

(2022). Association of adverse childhood experiences with subjective cognitive decline in adulthood: Findings from a population-based study. Aging and Mental Health, 26(11), 2214–2222. https://doi.org/10.1080/13607863.2021.2017848

Blazer

D. G.

Hays

J. C.

Fillenbaum

G. G.

Gold

D. T.

(1997). Memory complaint as a predictor of cognitive decline: a comparison of African American and White elders. Journal of Aging and Health, 9(2), 171–184. https://doi.org/10.1177/089826439700900202

Brown

M. J.

Hill

N. L.

Haider

M. R.

(2022a). Age and gender disparities in depression and subjective cognitive decline-related outcomes. Aging and Mental Health, 26(1), 48–55. https://doi.org/10.1080/13607863.2020.1861214

10.

Brown

M. J.

Joseph

James

Haider

M. R.

Zahnd

W. E.

Cohen

S. A.

(2022b). Gender and racial/ethnic disparities in social determinants of health and subjective cognitive decline: The mediating role of depression. Journal of Gerontological Nursing, 48(2), 13–22. https://doi.org/10.3928/00989134-20220110-01

11.

Brown

M. J.

Masho

S. W.

Perera

R. A.

Mezuk

Cohen

S. A.

(2015). Sex and sexual orientation disparities in adverse childhood experiences and early age at sexual debut in the United States: Results from a nationally representative sample. Child Abuse and Neglect, 46, 89–102. https://doi.org/10.1016/j.chiabu.2015.02.019

12.

Brown

M. J.

Masho

S. W.

Perera

R. A.

Mezuk

Pugsley

R. A.

Cohen

S. A.

(2017). Sex disparities in adverse childhood experiences and HIV/STIs: Mediation of psychopathology and sexual behaviors. AIDS and Behavior, 21(6), 1550–1566. https://doi.org/10.1007/s10461-016-1553-0

13.

Brown

M. J.

Nkwonta

C. A.

Kaur

James

Conserve

D. F.

Small

B. J.

Haley

W. E.

(2022). Psychologically and emotionally, it affects me “til this day”: Exploration of childhood sexual abuse perspectives among older adults living with HIV in South Carolina. Aging and Mental Health, 26(11), 2208–2213. https://doi.org/10.1080/13607863.2021.2007354

14.

Brown

M. J.

Patterson

(2020). Subjective cognitive decline among sexual and gender minorities: Results from a U.S. population-based sample. Journal of Alzheimer's Disease: JAD, 73(2), 477–487. https://doi.org/10.3233/JAD-190869

15.

Centers for Disease Control and Prevention . (2019). CDC - BRFSS. Centers for disease Control and prevention. https://www.cdc.gov/brfss/index.html

16.

Centers for Disease Control and Prevention . (2020). Preventing child sexual abuse violence prevention. https://www.cdc.gov/violenceprevention/childsexualabuse/fastfact.html

17.

Correro

A. N.

2nd Nielson

K. A.

(2020). A review of minority stress as a risk factor for cognitive decline in lesbian, gay, bisexual, and transgender (LGBT) elders. Journal of Gay and Lesbian Mental Health, 24(1), 2–19. https://doi.org/10.1080/19359705.2019.1644570

18.

Donley

G. A. R.

Lönnroos

Tuomainen

T. P.

Kauhanen

(2018). Association of childhood stress with late-life dementia and Alzheimer’s disease: The KIHD study. European Journal of Public Health, 28(6), 1069–1073. https://doi.org/10.1093/eurpub/cky134

19.

Downing

N. R.

Akinlotan

Thornhill

C. W.

(2021). The impact of childhood sexual abuse and adverse childhood experiences on adult health related quality of life. Child Abuse and Neglect, 120(2), 105181. https://doi.org/10.1016/j.chiabu.2021.105181

20.

Easton

S. D.

Kong

(2017). Mental health indicators fifty years later: A population-based study of men with histories of child sexual abuse. Child Abuse and Neglect, 63, 273–283. https://doi.org/10.1016/j.chiabu.2016.09.011

21.

Espinoza

(2014). Out and visible: The experiences and attitudes of lesbian, gay, bisexual and transgender older adults, ages 45–75. Retrieved from Sage (Services and Advocacy for GLBT Elders) website: http://www.sageusa.org/resources/outandvisible.cfm

22.

Ferraro

K. F.

Sauerteig-Rolston

M. R.

Barnes

L. L.

Friedman

Sands

L. P.

Thomas

P. A.

(2023). Subjective memory decline predicts incident cognitive impairment among White-but not Black or Hispanic-older adults. The Gerontologist, 63(4), 690–699. https://doi.org/10.1093/geront/gnac086

23.

Flatt

J. D.

Cicero

E. C.

Lambrou

N. H.

Wharton

Anderson

J. G.

Bouldin

E. D.

McGuire

L. C.

Taylor

C. A.

(2021). Subjective cognitive decline higher among sexual and gender minorities in the United States, 2015–2018. Alzheimer's and Dementia (New York, N. Y.), 7(1), Article e12197. https://doi.org/10.1002/trc2.12197

24.

Friedman

M. S.

Marshal

M. P.

Guadamuz

T. E.

Wei

Wong

C. F.

Saewyc

Stall

(2011). A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. American Journal of Public Health, 101(8), 1481–1494. https://doi.org/10.2105/AJPH.2009.190009

25.

Goda

Murata

Nakano

Shiraiwa

Abiko

Nonaka

Iwase

Anami

Horie

(2020). Subjective and objective mental and physical functions affect subjective cognitive decline in community-dwelling elderly Japanese people. Healthcare, 8(3), 347. https://doi.org/10.3390/healthcare8030347

26.

Gold

A. L.

Meza

Ackley

S. F.

Mungas

D. M.

Whitmer

R. A.

Mayeda

E. R.

Miles

Eng

C. W.

Gilsanz

Glymour

M. M.

(2021). Are adverse childhood experiences associated with late-life cognitive performance across racial/ethnic groups: Results from the Kaiser healthy aging and diverse life experiences study baseline. BMJ Open, 11(2), Article e042125–e042128. https://doi.org/10.1136/bmjopen-2020-042125

27.

Gupta

(2021). Racial and ethnic disparities in subjective cognitive decline: A closer look, United States, 2015–2018. BMC Public Health, 21(1), 1173. https://doi.org/10.1186/s12889-021-11068-1

28.

Gustavson

D. E.

Jak

A. J.

Elman

J. A.

Panizzon

M. S.

Franz

C. E.

Gifford

K. A.

Reynolds

C. A.

Toomey

Lyons

M. J.

Kremen

W. S.

(2021). How well does subjective cognitive decline correspond to objectively measured cognitive decline? Assessment of 10–12 year change. Journal of Alzheimer’s Disease: JAD, 83(1), 291–304. https://doi.org/10.3233/JAD-210123

29.

Hailes

H. P.

Danese

Fazel

(2019). Long-term outcomes of childhood sexual abuse: an umbrella review. The Lancet. Psychiatry, 6(10), 830–839. https://doi.org/10.1016/S2215-0366(19)30286-X

30.

Hill

N. L.

McDermott

Mogle

Munoz

DePasquale

Wion

Whitaker

(2017). Subjective cognitive impairment and quality of life: A systematic review. International Psychogeriatrics, 29(12), 1965–1977. https://doi.org/10.1017/S1041610217001636

31.

Hospice of the Western Reserve . (2023). Trauma informed care for persons with dementia, brain failure and cognitive impairment. https://www.nhpco.org/wp-content/uploads/TIC_persons_with_dementia_etc.pdf

32.

Irish

Kobayashi

Delahanty

D. L.

(2010). Long-term physical health consequences of childhood sexual abuse: A meta-analytic review. Journal of Pediatric Psychology, 35(5), 450–461. https://doi.org/10.1093/jpepsy/jsp118

33.

Jang

Haley

W. E.

Choi

E. Y.

Franco

(2022). Racial/ethnic differences in correspondence between subjective cognitive ratings and cognitive impairment. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 30(5), 627–635. https://doi.org/10.1016/j.jagp.2021.10.015

34.

Jessen

Amariglio

R. E.

Buckley

R. F.

van der Flier

W. M.

Han

Molinuevo

J. L.

Rabin

Rentz

D. M.

Rodriguez-Gomez

Saykin

A. J.

Sikkes

S. A. M.

Smart

C. M.

Wolfsgruber

Wagner

(2020). The characterisation of subjective cognitive decline. The Lancet. Neurology, 19(3), 271–278. https://doi.org/10.1016/S1474-4422(19)30368-0

35.

Jones

R. N.

(2003). Racial bias in the assessment of cognitive functioning of older adults. Aging and Mental Health, 7(2), 83–102. https://doi.org/10.1080/1360786031000045872

36.

Joubert

Chainay

(2018). Aging brain: The effect of combined cognitive and physical training on cognition as compared to cognitive and physical training alone – a systematic review. Clinical Interventions in Aging, 13, 1267–1301. https://doi.org/10.2147/CIA.S165399

37.

King

S. D.

Richardson

V. E.

(2016). Influence of income, being partnered/married, resilience, and discrimination on mental health distress for midlife and older gay men. Journal of Gay and Lesbian Mental Health, 20(2), 127–151. https://doi.org/10.1080/19359705.2015.1127191

38.

Liew

(2019). Depression, subjective cognitive decline, and the risk of neurocognitive disorders. Alzheimer's Research and Therapy, 11(1), 70. https://doi.org/10.1186/s13195-019-0527-7

39.

Llabre

M. M.

Schneiderman

Gallo

L. C.

Arguelles

Daviglus

M. L.

Gonzalez

2nd Isasi

C. R.

Perreira

K. M.

Penedo

F. J.

(2017). Childhood trauma and adult risk factors and disease in hispanics/latinos in the US: Results from the hispanic community health study/study of latinos (HCHS/SOL) sociocultural ancillary study. Psychosomatic Medicine, 79(2), 172–180. https://doi.org/10.1097/PSY.0000000000000394

40.

Matthews

K. A.

Gaglioti

A. H.

Holt

J. B.

Croft

J. B.

Mack

McGuire

L. C.

(2019). Racial and ethnic estimates of Alzheimer’s disease and related dementias in the United States (2015–2060) in adults aged ≥65 years. Alzheimer's and Dementia: The Journal of the Alzheimer's Association, 15(1), 17–24. https://doi.org/10.1016/j.jalz.2018.06.3063

41.

Mayeda

E. R.

Glymour

M. M.

Quesenberry

C. P.

Whitmer

R. A.

(2016). Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimer's and Dementia: The Journal of the Alzheimer’s Association, 12(3), 216–224. https://doi.org/10.1016/j.jalz.2015.12.007

42.

Mendonça

M. D.

Alves

Bugalho

(2016). From subjective cognitive complaints to dementia. American Journal of Alzheimer’s Disease and Other Dementias, 31(2), 105–114. https://doi.org/10.1177/1533317515592331

43.

Merrick

M. T.

Ford

D. C.

Ports

K. A.

Guinn

A. S.

(2018). Prevalence of adverse childhood experiences from the 2011–2014 behavioral risk factor surveillance system in 23 states. JAMA Pediatrics, 172(11), 1038–1044. https://doi.org/10.1001/jamapediatrics.2018.2537

44.

Molinuevo

J. L.

Rabin

L. A.

Amariglio

Buckley

Dubois

Ellis

K. A.

Ewers

Hampel

Klöppel

Rami

Reisberg

Saykin

A. J.

Sikkes

Smart

C. M.

Snitz

B. E.

Sperling

van der Flier

W. M.

Wagner

Jessen

Subjective Cognitive Decline Initiative SCD-I Working Group . (2017). Implementation of subjective cognitive decline criteria in research studies. Alzheimer's and Dementia: The Journal of the Alzheimer’s Association, 13(3), 296–311. Implementation https://doi.org/10.1016/j.jalz.2016.09.012

45.

Nakayama

Hori

Itoh

Lin

Niwa

Ino

Imai

Ogawa

Sekiguchi

Matsui

Kunugi

Kim

(2020). Possible long-term effects of childhood maltreatment on cognitive function in adult women with posttraumatic stress disorder. Frontiers in Psychiatry, 11, 344. https://doi.org/10.3389/fpsyt.2020.00344

46.

Navalta

C. P.

Polcari

Webster

D. M.

Boghossian

Teicher

M. H.

(2006). Effects of childhood sexual abuse on neuropsychological and cognitive function in college women. The Journal of Neuropsychiatry and Clinical Neurosciences, 18(1), 45–53. https://doi.org/10.1176/jnp.18.1.45

47.

Perales-Puchalt

Gauthreaux

Flatt

Teylan

M. A.

Resendez

Kukull

W. A.

Chan

K. C. G.

Burns

Vidoni

E. D.

(2019). Risk of dementia and mild cognitive impairment among older adults in same-sex relationships. International Journal of Geriatric Psychiatry, 34(6), 828–835. https://doi.org/10.1002/gps.5092

48.

Petrov

M. E.

Davis

M. C.

Belyea

M. J.

Zautra

A. J.

(2016). Linking childhood abuse and hypertension: Sleep disturbance and inflammation as mediators. Journal of Behavioral Medicine, 39(4), 716–726. https://doi.org/10.1007/s10865-016-9742-x

49.

Radford

Delbaere

Draper

Mack

H. A.

Daylight

Cumming

Chalkley

Minogue

Broe

G. A.

(2017). Childhood stress and adversity is associated with late-life dementia in aboriginal Australians. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 25(10), 1097–1106. https://doi.org/10.1016/j.jagp.2017.05.008

50.

Rich-Edwards

J. W.

Spiegelman

Lividoti Hibert

E. N.

Jun

H. J.

Todd

T. J.

Kawachi

Wright

R. J.

(2010). Abuse in childhood and adolescence as a predictor of type 2 diabetes in adult women. American Journal of Preventive Medicine, 39(6), 529–536. https://doi.org/10.1016/j.amepre.2010.09.007

51.

Riley

E. H.

Wright

R. J.

Jun

H. J.

Hibert

E. N.

Rich-Edwards

J. W.

(2010). Hypertension in adult survivors of child abuse: Observations from the nurses’ health study II. Journal of Epidemiology and Community Health, 64(5), 413–418. https://doi.org/10.1136/jech.2009.095109

52.

Roberts

A. L.

Austin

S. B.

Corliss

H. L.

Vandermorris

A. K.

Koenen

K. C.

(2010). Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. American Journal of Public Health, 100(12), 2433–2441. https://doi.org/10.2105/AJPH.2009.168971

53.

Sacks

Murphey

(2018). The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity, https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity.

54.

Sánchez-Benavides

Grau-Rivera

Suárez-Calvet

Minguillon

Cacciaglia

Gramunt

Falcon

Gispert

J. D.

Molinuevo

J. L.

ALFA Study . (2018). Brain and cognitive correlates of subjective cognitive decline-plus features in a population-based cohort. Alzheimer’s Research and Therapy, 10(1), 123. https://doi.org/10.1186/s13195-018-0449-9

55.

Saunders

B. E.

Villeponteaux

L. A.

Lipovsky

J. A.

Kilpatrick

D. G.

Veronen

L. J.

(1992). Child Sexual Assault as a Risk Factor for Mental Disorders Among Women: A Community Survey. Journal of Interpersonal Violence, 7(2), 189–204. https://doi.org/10.1177/088626092007002005

56.

Sikkema

K. J.

Ranby

K. W.

Meade

C. S.

Hansen

N. B.

Wilson

P. A.

Kochman

(2013). Reductions in traumatic stress following a coping intervention were mediated by decreases in avoidant coping for people living with HIV/AIDS and childhood sexual abuse. Journal of Consulting and Clinical Psychology, 81(2), 274–283. https://doi.org/10.1037/a0030144

57.

Tani

Fujiwara

Kondo

(2021). Adverse childhood experiences and dementia: Interactions with social capital in the Japan gerontological evaluation study cohort. American Journal of Preventive Medicine, 61(2), 225–234. https://doi.org/10.1016/j.amepre.2021.01.045

58.

Taylor

C. A.

Bouldin

E. D.

McGuire

L. C.

(2018). Subjective cognitive decline among adults aged ≥45 years — United States, 2015–2016. MMWR. Morbidity and Mortality Weekly Report, 67(27), 753–757. https://doi.org/10.15585/mmwr.mm6727a1

59.

Wang

Tian

Alzheimer’s Disease Neuroimaging Initiative . (2018). Gender differences in elderly with subjective cognitive decline. Frontiers in Aging Neuroscience, 10, 166. https://doi.org/10.3389/fnagi.2018.00166