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Frontiers in Psychiatry 2022Sexual violence is a phenomenon that negatively impacts the victims' physical and psychological health and well-being. Sex offenders tend not to take responsibility for...
Sexual violence is a phenomenon that negatively impacts the victims' physical and psychological health and well-being. Sex offenders tend not to take responsibility for their actions, have difficulties in emotion regulation and impulse control, paraphilias or other disorders, so they are a difficult group to treat. In addition, the available psychological treatment programs tend to have inconsistent and, sometimes, undesirable results. This systematic review aimed to analyse the recidivism rates of sex offenders treated in community settings. According to the PRISMA guidelines, a systematic search in three databases, EBSCOhost, PubMed, and Web of Science, and a manual search was performed. A total of 319 empirical studies using quantitative methodologies were identified, 27 of which were selected for full-text analysis. In the end, 15 studies were included, published between 1996 and 2020. The objectives, intervention approach, instruments used, and the main results and conclusions were extracted from each study. The studies explored different types of sex offenders, such as: violent sex offenders (e.g., rapists), child abusers, and child abusers with pedophilia (and/or other paraphilias). Results showed that most of the programs had a cognitive-behavioral approach ( = 13). Overall, the interventions appear to be effective in reducing recidivism rates, and some of them led to improvements in other outcomes, such as cognitive distortions, accepting responsibility, victim awareness and empathy, emotional regulation, and offense supportive attitudes. Limitations and implications for future studies were discussed.
PubMed: 36506440
DOI: 10.3389/fpsyt.2022.949899 -
Child Abuse & Neglect Dec 2023Sexual violence is a major public health issue worldwide, with a high prevalence and extensive human and financial costs. Implementing prevention programs is complex,... (Review)
Review
BACKGROUND
Sexual violence is a major public health issue worldwide, with a high prevalence and extensive human and financial costs. Implementing prevention programs is complex, requiring not only evidence-based practices and high ethical standards, but also close collaboration with local governments and non-governmental organizations. In order to guide and support all stakeholders necessary to achieve large-scale prevention (e.g., politicians, decision-makers, in-field professionals), it is essential to establish international benchmarks for the prevention of sexual violence.
OBJECTIVE
The main goal of this collaborative study was to conduct a systematic review of the frameworks adopted by WHO, UN Women, UNESCO, and UNICEF to help prevent sexual violence worldwide, according to the PRISMA methodology. A secondary objective was to highlight the levels of prevention and determinants of health targeted by these organizations.
RESULTS
Overall, 1008 references were identified, of which 50 met the inclusion criteria. All international guidelines were limited to primary or tertiary prevention, and they were not specifically dedicated to sexual violence. In addition, each organization had developed idiosyncratic prevention strategies. Common primary prevention determinants of health were still found across organizations, including education, socio-economic inequalities, and life skills training. Tertiary prevention was poorly developed and polarized between victims and perpetrators. Secondary prevention was never addressed, however, despite the effectiveness of approaches such as helplines for people sexually attracted to children.
DISCUSSION
Given these results, an international French-speaking consortium of professional teams, all involved in the secondary prevention of sexual violence, was recently formed with a ratified charter presented here.
Topics: Child; Humans; Female; UNESCO; Sex Offenses; Sexual Behavior; Public Health; World Health Organization
PubMed: 37832246
DOI: 10.1016/j.chiabu.2023.106497 -
Current Psychiatry Reports Apr 2024Web-based programs to prevent sexual offense perpetration could provide an opportunity that avoids many of the barriers associated with in-person treatment. The aim of... (Review)
Review
PURPOSE OF REVIEW
Web-based programs to prevent sexual offense perpetration could provide an opportunity that avoids many of the barriers associated with in-person treatment. The aim of this systematic review is to give an overview of the literature on web-based initiatives aimed at sexual offense perpetration prevention published during the last 10 years (2013-2023) and to report data on the efficacy as well as issues of the discussed initiatives.
RECENT FINDINGS
We included 18 empirical studies discussing web-based perpetration prevention initiatives, of which six are randomized controlled trials. Among the articles, four cover programs focusing on prevention of sexual reoffending and 14 discuss programs aimed at preventing initial sexual offenses. Evaluations and observations of web-based initiatives aimed at preventing sexual offense perpetration show overall promising results and are well-appreciated. However, evaluation studies are scarce and more randomized controlled trials replicating this effect are warranted.
Topics: Humans; Sex Offenses; Sexual Behavior; Internet
PubMed: 38509408
DOI: 10.1007/s11920-024-01489-1 -
Frontiers in Psychology 2021In 2013, there were an estimated 50,000 individuals involved in downloading and sharing indecent images of children (IIOC) in the United Kingdom (UK). This poses...
In 2013, there were an estimated 50,000 individuals involved in downloading and sharing indecent images of children (IIOC) in the United Kingdom (UK). This poses challenges for limited police resources. We argue that police officers can make most effective use of limited resources by prioritizing those offenders who pose the greatest risk of contact offending, by nature of demonstrable pedophilia, hebephilia or dual offending status and thus, those at highest risk must be dealt with first. What is currently lacking is a clear idea of the potential scale of the problem in socio-economic terms and why, therefore, it is so important that evidence-based approaches to offender detection and investigation continue to be a top priority for funders and policy makers. A systematic literature review was undertaken to address two related questions. First, what is the scale of the problem in the UK, in terms of the number of pedophilic and hebephilic individuals who pose a risk of contact offending against a child? Second, what is the potential socio-economic burden generated by the national IIOC suspect pool if left unattended to by targeted police action? Applying population estimates of pedophilia and hebephilia to the male population (16-89 years), we estimate there are between 2,365-5,991 males with paedophila and 12,218-30,952 males with hebephilia who are likely contact offenders. Applying average prevalence and incidence based costing methods to a conservative estimate of one victim per offender, the combined socio-economic burden from these persons could amount to £236-£597 million (incident costs) increasing to £2.9-£7.3 billion (lifetime costs; £3.3-£8.3 billion including QALY measures). Applying the same costs to CEOP (2013) estimate of 50,000 IIOC offenders we estimate that between 6,000 and 27,500 dual offenders could have already committed past contact offenses, contributing an economic burden of between £97-£445 million (incident costs) increasing to £1.2-£5.4 billion (lifetime costs; £1.4-£6.2 billion including QALY measures). Future contact offenses could contribute a further burden of £16-£18.6 million (incident costs) increasing to £198-£227 million (lifetime costs; £226-£260 million including QALY measures). Drawing upon these findings, we argue for the benefits of a research-informed prioritization approach to target IIOC offenders.
PubMed: 33633637
DOI: 10.3389/fpsyg.2021.606731 -
International Journal of Sexual Health... 2021The stigmatization of people with pedophilia was previously identified as a "blind spot" in stigma research. This systematic review updates and expands on Jahnke and...
The stigmatization of people with pedophilia was previously identified as a "blind spot" in stigma research. This systematic review updates and expands on Jahnke and Hoyer's 2013 review to understand (1) factors contributing to stigma toward people with sexual interest in children, (2) experiences of stigma, and (3) how stigma can be challenged and reduced. Thematic synthesis was used to analyze data from 35 studies from the United Kingdom, United States, The Netherlands, Germany, Canada, Norway, Australia, and New Zealand. Overarching themes were (1) misperceptions and stereotypes, (2) negative affective responses, (3) discrimination, (4) mental distress, (5) internalized public stigma, (6) negative effects of disclosure, and (7 and 8) informative and humanizing interventions. Findings highlighted substantial prevalence of stigma toward and amongst people with sexual interest in children, and methodological limitations of extant research. An agenda for future research is discussed, emphasizing how stigma can be challenged.
PubMed: 38596748
DOI: 10.1080/19317611.2020.1865498 -
The Cochrane Database of Systematic... Oct 2008Sexual offending is both a social problem and a public health issue. To date, no positive treatment effects have been found in quasi-experimental institutional treatment... (Review)
Review
BACKGROUND
Sexual offending is both a social problem and a public health issue. To date, no positive treatment effects have been found in quasi-experimental institutional treatment programmes.
OBJECTIVES
To evaluate effects of psychological interventions on target sexual acts, urges or thoughts for people who have been convicted, or cautioned, for sexual offences.
SEARCH STRATEGY
33 electronic databases including the Cochrane Controlled Trials Register (Issue 4, 2002) were searched. Relevant authors and organisations were contacted for additional data.
SELECTION CRITERIA
Randomised controlled trials (RCTs) involving adults treated in institutional or community settings for sexual behaviours that have resulted in conviction or caution for sexual offences, or offences or violent behaviours with a sexual element. Behavioural, cognitive-behavioural, psychodynamic, and psychoanalytic therapies were compared with each other, drug treatment, or standard care.
DATA COLLECTION AND ANALYSIS
Independent assessors selected and assessed studies and extracted data. Data were excluded where more than 50% of participants were lost to follow-up. For binary outcomes, standard estimations of risk ratio (RR) and their 95% confidence intervals (CI) were calculated. Where possible, number-needed-to-treat or harm statistics (NNT, NNH) and their 95% CIs were calculated.
MAIN RESULTS
We included nine RCTs with over 500 male offenders, 231 of whom have been followed up for a decade. Cognitive behavioural therapy (CBT) in groups may reduce re-offence at one year for child molesters when compared with standard care (n=155, 1 RCT, RR any sexual/violent crime - 0.41 CI 0.2 to 0.82, NNT 6 CI 3 to 20). However, when CBT was compared with a trans-theoretical counselling group therapy the former may have increased poor attitudes to treatment (corrected n=38, 1 RCT, RR 2.8 CI 1.26 to 6.22, NNH 2 CI 1 to 5). The largest trial compared broadly psychodynamic group therapy with no treatment for 231 men guilty of paedophilia, exhibitionism or sexual assault. Re-arrest over ten years was greater for those allocated to group therapy (result not statistically significant [n=231, 1 RCT, RR 1.87 CI 0.78 to 4.47]).
AUTHORS' CONCLUSIONS
Limited data make recommendations difficult. One study suggests that a cognitive approach results in a decline in re-offending after one year. Another large study shows no benefit for group therapy and suggests the potential for harm at ten years. The ethics of providing this still-experimental treatment to a vulnerable and potentially dangerous group of people outside of a well-designed evaluative study are debatable. This review proves such studies are possible.
Topics: Humans; Male; Paraphilic Disorders; Psychoanalysis; Psychotherapy; Randomized Controlled Trials as Topic; Sex Offenses
PubMed: 18843670
DOI: 10.1002/14651858.CD004858.pub2