Prevalence of Sexual Abuse in Adults with Intellectual Disability: Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search and Selection Strategy
2.2. Inclusion and Exclusion Criteria
- (a)
- Characteristics of participants. Studies were included if they were conducted on or included adults (18+) with Intellectual and/or Developmental Disabilities (ID/DD) as defined by the ICD [3], DSM [4], or the AAIDD [6]. Participants must have experienced sexual abuse; this ranges from verbal harassment or unwanted sexual advances to forced penetration, and an array of types of coercion, from social pressure and intimidation to physical force. Behaviors such as exposing the genitals or looking at or touching certain parts of a victim’s body or requiring the victim to perform sexual acts are defined as sexual abuse. Several characteristics must apply to the victim: (1) he/she withholds the consent, or (2) is unable to give informed consent to, or is not developmentally prepared, or (3) the victim is unduly pressured due to the relationship (e.g., familial), the use of force, a weapon, or threats. Studies were included if they referred to adult samples, and if samples were over 10 subjects.
- (b)
- Characteristics of intervention, factor, or exposure. Studies were included if they reported data of sexual abuse.
- (c)
- Characteristics of comparison or control. For the meta-analysis, studies were included if they used control groups with intellectual disability who were not victims of sexual abuse. They also were included if they used comparison groups from the general population consisting of participants without intellectual disability who were victims of sexual abuse.
- (d)
- Characteristics of outcome. Studies reported prevalence of sexual abuse on population (total, females, and males) with intellectual disability.
2.3. Quality Assessment
3. Results
3.1. Qualitative Synthesis
3.2. Quantitative Synthesis (Meta-Analysis)
3.3. Prevalence of Sexual Abuse in Adults with Intellectual Disability
3.4. Publication Bias
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
First Author | Year | C1 | Study (1) | C2 | C3 | C4 | C5 | C6 | C7 | C8 | C9 | C10 | C11 | C12 | C13 | C14 | Quality Rating |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Aker [28] | 2020 | Yes | Cross-Sectional | Yes | Yes | Yes | Yes | No | CD | CD | Yes | No | Yes | No | No | CD | Fair |
Allington [29] | 2009 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | CD | Yes | Yes | No | No | CD | CD | CD | Fair |
Beadle-Brown [30] | 2010 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | Yes | CD | Yes | No | Yes | No | No | CD | Fair |
Beail [31] | 1995 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | Yes | CD | Yes | No | Yes | No | No | CD | Fair |
Brown [32] | 1994 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | Yes | CD | Yes | No | Yes | No | No | CD | Fair |
Buchanan [33] | 1991 | Yes | Cross-Sectional | Yes | No | Yes | Yes | Yes | CD | Yes | Yes | No | CD | CD | CD | CD | Fair |
Cambridge [34] | 2011 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | Yes | CD | Yes | No | Yes | No | No | CD | Fair |
Dickman [35] | 2005 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | Yes | CD | Yes | No | Yes | No | No | CD | Fair |
Dunne [36] | 1990 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | Yes | CD | Yes | No | Yes | No | No | CD | Fair |
ELvik [37] | 1990 | Yes | Cross-Sectional | Yes | No | Yes | Yes | Yes | CD | Yes | Yes | No | CD | CD | CD | CD | Fair |
Furey [38] | 1994 | CD | Cross-Sectional | Yes | Yes | Yes | Yes | No | CD | Yes | CD | No | CD | No | No | CD | Fair |
Furey [39] | 1994 | Yes | Case-control | Yes | Yes | Yes | Yes | Yes | CD | Yes | CD | Yes | CD | CD | Fair | ||
Furey [40] | 1994 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | Yes | CD | Yes | No | Yes | No | CD | No | Fair |
Gil-Llario [41] | 2018 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | Yes | Yes | Yes | No | Yes | No | No | CD | Fair |
Gil-Llario [42] | 2019 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | CD | CD | Yes | No | Yes | No | No | CD | Fair |
Haydon [43] | 2011 | Yes | Cross-Sectional | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | No | Yes | No | No | CD | Fair |
Lewin [44] | 2007 | Yes | Cross-Sectional | Yes | No | Yes | Yes | Yes | CD | Yes | Yes | No | Yes | CD | CD | CD | Fair |
Lin [45] | 2009 | Yes | Cross-Sectional | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | No | Yes | No | No | CD | Fair |
Majeed-Ariss [46] | 2020 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | Yes | Yes | Yes | No | Yes | No | No | CD | Fair |
McCabe [47] | 1994 | Yes | Case-control | Yes | No | Yes | Yes | Yes | CD | Yes | CD | CD | CD | CD | Fair | ||
McCarthy [48] | 1997 | CD | Cross-Sectional | Yes | Yes | Yes | No | No | CD | Yes | Yes | No | Yes | No | No | CD | Fair |
McCartney [49] | 1998 | Yes | Cross-Sectional | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | No | Yes | No | No | CD | Fair |
McCormack [50] | 2005 | Yes | Case-control | Yes | Yes | Yes | No | No | Yes | Yes | Yes | No | Yes | No | No | CD | Fair |
Pan [51] | 2007 | Yes | Case-control | Yes | Yes | Yes | No | No | CD | CD | Yes | No | Yes | No | No | CD | Fair |
Sequeira [52] | 2003 | Yes | Case-control | Yes | Yes | Yes | Yes | Yes | CD | Yes | CD | Yes | CD | CD | Fair | ||
Shabalala [53] | 2011 | Yes | Case-control | Yes | Yes | Yes | Yes | Yes | CD | Yes | CD | Yes | CD | CD | Fair | ||
Sobsey [54] | 1991 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | CD | CD | Yes | No | Yes | No | No | CD | Fair |
Stoffelen [55] | 2013 | Yes | Cross-Sectional | Yes | CD | Yes | No | Yes | Yes | No | Yes | No | Yes | No | No | No | Fair |
Turk [56] | 1993 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | Yes | Yes | Yes | No | Yes | No | No | CD | Fair |
Vadysinghe [57] | 2017 | Yes | Cross-Sectional | Yes | Yes | Yes | No | No | Yes | CD | Yes | No | Yes | No | No | CD | Fair |
First Author | Year | Period of Publication | Context | Country | ID Abused | Total Sample | Women ID Abused | Tot Women | Men ID Abused | Tot Men | Age | Severity ID | Abuser | Informer |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Beadle-Brown [30] | 2010 | 3 | non-clinical | UK | 333 | 1926 | NA | NA | NA | NA | 38.9 | moderate | Several | NA |
Beail [31] | 1995 | 2 | non-clinical | UK | 22 | 963 | 3 | 963 | 3 | NA | 29.5 | mild | Home | other |
Brown [32] | 1994 | 1 | non-clinical | UK | 84 | 119 | 87 | 119 | 23 | 31 | 31 | moderate | Several | user |
Buchanan [33] | 1991 | 1 | non-clinical | USA | 25 | 847 | 12 | 847 | 11 | NA | 28 | moderate | Institution | other |
Cambridge [34] | 2011 | 3 | non-clinical | UK | 321 | 1857 | 116 | 6148 | 100 | NA | 34.02 | moderate | Institution | other |
Elvik [37] | 1990 | 1 | non-clinical | USA | 13 | 35 | 5 | 35 | NA | NA | 24 | profound | Institution | other |
Furey [38] | 1994 | 1 | clinical | USA | 171 | 461 | 123 | 461 | 46 | 46 | 30 | moderate | Institution | user |
Gil-Llario [41] | 2018 | 3 | non-clinical | Spain | 22 | 360 | 2 | 360 | 5 | 180 | NA | moderate | Service | other |
Gil-Llario [42] | 2019 | 3 | non-clinical | Spain | 125 | 360 | 35 | 360 | 53 | 180 | 50 | moderate | Service | both |
Haydon [43] | 2011 | 3 | non-clinical | USA | 53 | 11878 | 33 | 53 | 20 | 5428 | NA | mild | Several | both |
Lewin [44] | 2007 | 2 | non-clinical | Sweden | 23 | 42 | 6 | 7 | 1 | 10 | 50 | moderate | Institution | other |
Lin [45] | 2009 | 3 | non-clinical | Taiwan | 1071 | 2005 | 0 | 2005 | NA | NA | NA | NA | Several | both |
Majeed-Ariss [46] | 2020 | 3 | non-clinical | UK | 56 | 688 | 50 | 679 | 6 | 56 | 21.5 | mild | Several | other |
McCabe [47] | 1997 | 2 | non-clinical | Australia | 8 | 30 | 0 | 30 | NA | 12 | 25.2 | mild | Home | user |
McCarthy [48] | 1998 | 2 | non-clinical | UK | 70 | 185 | 43 | 185 | 30 | 120 | NA | mild | Institution | user |
McCartney [49] | 2005 | 2 | non-clinical | USA | 10 | 494 | 6 | 494 | 6 | 296 | NA | profound | Institution | other |
McCormack [50] | 2007 | 2 | non-clinical | Ireland | 74 | 118 | 39 | 118 | NA | NA | NA | severe | Service | user |
Pan [51] | 2003 | 2 | non-clinical | Taiwan | 18 | 336 | 10 | 336 | 8 | 190 | NA | mild | Several | user |
Sequeira [52] | 1991 | 1 | non-clinical | UK | 54 | 108 | 36 | 108 | 18 | 18 | 29.4 | mild | Institution | both |
Shabalala [53] | 2013 | 3 | non-clinical | South Africa | 27 | 54 | 24 | 54 | 3 | 3 | 18 | mild | Several | both |
Sobsey [54] | 1993 | 1 | non-clinical | Canada | 114 | 162 | 93 | 162 | NA | 30 | 19.2 | severe | Several | other |
Stoffelen [55] | 2017 | 3 | non-clinical | The Netherlands | 10 | 21 | 0 | 21 | 10 | 19 | 40.5 | mild | Several | user |
Turk [56] | 1993 | 1 | non-clinical | UK | 85 | 119 | 62 | 119 | 23 | 31 | 29 | moderate | Several | other |
Vadysinghe [57] | 2017 | 3 | clinical | Sri Lanka | NA | NA | 74 | 82 | 8 | 82 | 28.3 | mild | Home | NA |
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First Author * | Year | Country | Context | Type of Study | Temporal Direction | Prevalence/ Incidence | Point/ Period | Length of Study |
---|---|---|---|---|---|---|---|---|
* Aker [28] | 2020 | Norway | clinical | Cross-sectional | Retrospective | PR | PE | 2 |
* Allington [29] | 2009 | UK | clinical | Cross-sectional | Retrospective | PR | PO | |
Beadle-Brown [30] | 2010 | UK | clinical | Longitudinal | Retrospective | PR | PE | 0.8 |
Beail [31] | 1995 | UK | clinical | Cross-sectional | Retrospective | PR | PE | 4 |
Brown [32] | 1994 | UK | clinical | Longitudinal | Retrospective | IN | PE | 3 |
Buchanan [33] | 1991 | USA | clinical | Cross-sectional | Retrospective | PR | PO | |
Cambridge [34] | 2011 | UK | clinical | Longitudinal | Retrospective | PR | PE | 5 |
* Dickman [35] | 2005 | South Africa | clinical | Cross-sectional | Retrospective | PR | PE | 10 |
* Dunne [36] | 1990 | Ireland | clinical | Cross-sectional | Retrospective | PR | PE | 3 |
Elvik [37] | 1990 | USA | non-clinical | Cross-sectional | Retrospective | PR | PO | |
Furey [38] | 1994 | USA | clinical | Cross-sectional | Retrospective | PR | PE | 5 |
* Furey [39] | 1994 | USA | clinical | Case-control | Retrospective | PR | PE | 5 |
* Furey [40] | 1994 | USA | clinical | Cross-sectional | Retrospective | PR | PE | 5 |
Gil-Llario [41] | 2018 | Spain | non-clinical | Cross-sectional | Retrospective | PR | PO | |
Gil-Llario [42] | 2019 | Spain | non-clinical | Cross-sectional | Retrospective | PR | PO | |
Haydon [43] | 2011 | USA | non-clinical | Cross-sectional | Retrospective | PR | PE | 1 |
Lewin [44] | 2007 | Sweden | clinical | Cross-sectional | Retrospective | PR | PO | |
Lin [45] | 2009 | Taiwan | clinical | Longitudinal | Retrospective | PR/IN | PE | 6 |
Majeed-Ariss [46] | 2020 | UK | clinical | Cross-sectional | Retrospective | PR | PE | 1 |
McCabe [47] | 1994 | UK | non-clinical | Case-control | Retrospective | PR | PO | |
McCarthy [48] | 1997 | USA | non-clinical | Cross-sectional | Retrospective | PR | PE | 5 |
McCartney [49] | 1998 | Ireland | clinical | Cross-sectional | Retrospective | PR | PE | 2 |
McCormack [50] | 2005 | Taiwan | clinical | Cross-sectional | Retrospective | PR | PO | 15 |
Pan [51] | 2007 | UK | non-clinical | Cross-sectional | Retrospective | PR | PO | |
Sequeira [52] | 2003 | Sweden | clinical | Case-control | Retrospective | PR | PO | |
Shabalala [53] | 2011 | South Africa | clinical | Case-control | Retrospective | PR | PO | |
Sobsey [54] | 1991 | Canada | clinical | Cross-sectional | Retrospective | PR | PE | 2 |
Stoffelen [55] | 2013 | The Netherlands | clinical | Cross-sectional | Retrospective | PR | PO | |
Turk [56] | 1993 | UK | clinical | Cross-sectional | Retrospective | PR | PE | 3 |
Vadysinghe [57] | 2017 | Sri Lanka | clinical | Cross-sectional | Retrospective | PR | PE | 5 |
Subgroups | Studies | Pooled Prevalence (%) | SE | p | Hete I2(%) | Q | p |
---|---|---|---|---|---|---|---|
Several | 10 | 39.1 (21.1–57.1) | 0.092 | <0.001 | 100 | 3710.49 | <0.001 |
Home | 2 | 13.1 (−10.6–36.9) | 0.121 | 0.278 | 89 | 9.09 | <0.003 |
Institution | 7 | 28.1 (12.0–44.1) | 0.082 | <0.001 | 99 | 450.19 | <0.001 |
Service | 3 | 34.3 (2.3–66.3) | 0.163 | 0.036 | 99 | 226.23 | <0.001 |
Place | 22 | 32.7 (22.1–43.3) | 0.054 | <0.001 | 100 | 4767.23 | <0.001 |
Professionals | 3 | 17.6 (−1.9–37.0) | 0.099 | 0.076 | 99 | 216.93 | <0.001 |
Relatives | 2 | 36.2 (−30.5–100) | 0.340 | 0.287 | 100 | 353.80 | <0.001 |
Peers | 6 | 42.7 (19.7–65.7) | 0.117 | <0.001 | 99 | 516.21 | <0.001 |
Several | 7 | 25.4 (10.0–40.8) | 0.079 | 0.001 | 98 | 336.73 | <0.001 |
nonspec | 4 | 39.2 (13.2–65.2) | 0.133 | 0.003 | 100 | 2356.46 | <0.001 |
Abuser | 22 | 32.7 (22.1–43.3) | 0.054 | <0.001 | 100 | 4767.23 | <0.001 |
Mild | 9 | 24.3 (10.2–38.4) | 0.072 | <0.001 | 98 | 381.07 | <0.001 |
Moderate | 8 | 34.0 (14.7–53.4) | 0.099 | <0.001 | 99 | 849.21 | <0.001 |
Severe | 2 | 67.0 (59.5–74.4) | 0.038 | <0.001 | 44 | 1.79 | 0.180 |
Profound | 2 | 18.6 (−15.7–53.0) | 0.175 | 0.288 | 95 | 18.38 | <0.001 |
Severity | 21 | 31.7 (20.7–42.7) | 0.056 | <0.001 | 99 | 2545.31 | <0.001 |
User | 7 | 38.0 (20.1–55.8) | 0.091 | <0.001 | 99 | 403.47 | <0.001 |
Other | 10 | 26.8 (9.0–44.6) | 0.091 | 0.003 | 99 | 917.27 | <0.001 |
Both | 5 | 37.4 (17.9–56.9) | 0.100 | <0.001 | 100 | 2596.75 | <0.001 |
Informant | 22 | 32.7 (22.1–43.3) | 0.054 | <0.001 | 100 | 4767.23 | <0.001 |
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Tomsa, R.; Gutu, S.; Cojocaru, D.; Gutiérrez-Bermejo, B.; Flores, N.; Jenaro, C. Prevalence of Sexual Abuse in Adults with Intellectual Disability: Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18, 1980. https://doi.org/10.3390/ijerph18041980
Tomsa R, Gutu S, Cojocaru D, Gutiérrez-Bermejo B, Flores N, Jenaro C. Prevalence of Sexual Abuse in Adults with Intellectual Disability: Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2021; 18(4):1980. https://doi.org/10.3390/ijerph18041980
Chicago/Turabian StyleTomsa, Raluca, Smaranda Gutu, Daniel Cojocaru, Belén Gutiérrez-Bermejo, Noelia Flores, and Cristina Jenaro. 2021. "Prevalence of Sexual Abuse in Adults with Intellectual Disability: Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 18, no. 4: 1980. https://doi.org/10.3390/ijerph18041980
APA StyleTomsa, R., Gutu, S., Cojocaru, D., Gutiérrez-Bermejo, B., Flores, N., & Jenaro, C. (2021). Prevalence of Sexual Abuse in Adults with Intellectual Disability: Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 18(4), 1980. https://doi.org/10.3390/ijerph18041980