Detecting child sexual abuse in general practice: a retrospective case-control study from Wales

Abstract

Objective - To investigate if routine medical contacts provide indicators that would assist general practitioners in detecting male child abuse. Design - A case-control study of the general practice records of male victims of a major episode of school-based child abuse and matched controls. Setting - General practices serving cases and controls from two South Wales schools. Subjects - 107 abused boys and 107 aged-matched controls. Results - No boys had disclosed sexual abuse to general practitioners. Somatic and behavioural symptoms were reported by small numbers in both groups (18 cases/25 controls). Odds ratios showed no significant positive association between abuse and numbers of boys presenting with symptoms (odds ratio 0.66; 95% confidence interval 0.32-1.37), and no difference could be found in the nature of the symptoms complained of by boys from the two groups. However, abused boys were more likely than controls to present with symptoms that persisted for more than a year (eight cases compared with one control). The two-tailed p-value calculated using the Fisher exact test was 0.035, suggesting a statistically significant association between abuse and persistent symptoms. Conclusions - Sexually-abused boys are unlikely to visit general practitioners with open requests for help, and do not appear to present with behavioural or somatic symptoms different from those presented by non-abused boys. However, where boys complain of persistent, inexplicable, somatic or behaviour problems over a period of time, the possibility of abuse should be considered.