SEXUAL ABUSE IN CHINESE CHILDREN IN HONG KONG: A REVIEW OF 134 CASES T.P. Ho, F. Lieh Mak
This is a retrospective study of 134 cases of sexual abuse in Chinese children aged 16 years or under in Hong Kong. The data with respect to the victim’s age, sex, severity and type (intra- or extrafamilial) of abuse, perpetrator’s characteristics and family disturbances were analysed. The overall profile is similar to that reported in the West. The reasons for the apparently low prevalence, younger age of victim and low proportion of male victims are discussed. Australian and New Zealand Journal of Psychiatry 1992; 26:639-643 Ethnic differences in child sexual abuse is a relatively unexplored area. Most studies in this area were concerned with prevalence rates. Compared with white Americans, the prevalence rate was reported to be higher for Hispanic women [ 1,2], similar for AfroAmericans [3] and lower for Asian and Jewish women [ 11. These studies were based on community samples and the overall refusal rate was 40-50% with varying proportions across different ethnic groups. For example, Kercher et al[2] reported a tendency of AfroAmericans and Hispanics to be less inclined to participate in mailed surveys. This put in doubt the reported differences in prevalence rates. Studies examining the characteristics of sexual abuse in other ethnic groups were limited to Afro-Americans. Overall, there were remarkable similarities despite the fact that different family constellations in the AfroAmerican community might account for the predominance of step-fathers and male cousins as perpetrators. The onset of abuse was later in childhood
Department of Psychiatry, University of Hong Kong, Hong Kong T.P. Ho MBBS. MRCPsych, Lecturer F. Lieh Mak MD, FRCPsych, FRANZCP, Professor and Head Correspond with Dr Ho
in the Afro-Americans than for the white Americans
PI. Apart from case reports [4-61, there were very few studies on child sexual abuse in the Chinese. A search in Medline from 1984 to April 1990 revealed only a single paper on this topic [4]. An earlier study by Law [7] reported a total of 155 child molesters and 183 victims. Besides sex, age and relationship with molesters, there were no further descriptions of the victims. The focus was on the offenders. To achieve a better understanding of the problem, there is a need to study a sizeable group of Chinese sexually abused children.
Methodology Four agencies cooperated in the study. They include the following: Against Child Abuse, Child Protective Services Unit of the Social Welfare Department, Youth Health Care Centre of the Family Planning Association in Hong Kong and the University Psychiatric Unit at Queen Mary Hospital. Most of the confirmed child abuse cases are referred to the first two agencies. The Youth Health Care Centre is aclinic for children and adolescents in need of sex counselling. The University Psychiatric Unit assesses and manages suspected abuse cases in a general hospital setting. An enquiry was conducted in other social
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SEXUAL ABUSE IN CHINESE CHILDREN IN HONG KONG
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Tuhte 1. Sex disrriburion and age at which abuse first occurred
lntrafamilial Extrafamilial Total n=24 (17.9%) 11~103 (76.9%) n=134(100%)
n
%
n
n
%
cases for the following variables: demographic characteristics of the child, parents and the family, characteristics of abusive events, modes of presentation, sources of referrals and outcomes. Most of the missing data were found in extrafamilial sexual abuse cases. Cases with missing information were omitted from statistical analysis.
%
Results ;ex 'emale Aale 4ge (years) :4 i-7 1-10 1-13 4-16 Jnknown
23 (95.8) 1 (4.2)
0 9 3 3 6 3
(0) (37.5) (12.5) (12.5) (25.0) (12.5)
98 (95.1) 5 (4.9)
128 (95.5) 6 (4.5)
3 (2.9) 8 (7.8) 5 (4.9) 43 (41.7) 43 (41.7) 1 (1.0)
3 (2.2) 17 (12.7) 8 (6.0) 48 (35.8) 51 (38.0) 7 (8.2)
The identity of perpetrator was missing in 7 cases
agencies in Hong Kong but it did not reveal any additional cases. The identity of victims were checked to prevent double entries. The sample collected represents victims who were referred to professionals in Hong Kong. The criteria for sexual abuse used in the study was as follows: I . The abuse should be sexual in nature, ranging from non-body contact, such as indecent exposure of the child's private body parts, to those involving body contact such as fondling and intercourse. 2. The abuse incident had to occur prior to 16, the age at which legal consent to have sex is reached. 3. The perpetrator was 5 years older than the subject. If the age difference was less than 5 years, only cases involving some degree of coercion were included. 4. Consent by the victim was immaterial. All cases fulfilling the criteria in the period January 1 1986 to January 1 1990 were included in the study. To ensure the quality of information gathered, draft questionnaires were sent out for trial and revised accordingly. The procedures for data collection were standardised for all agencies. Data concerning the characteristics of the victims, families, perpetrators, abusive events and outcomes were gathered by a review of the victims' files. A total of 134 cases were studied. Information was collected in over 85% of the
Table 1 presents the data relating to the sex of victims and the age at which abuse first occurred. Of the 134 victims, 128 (95.5%) were females and 6 (4.5%) were males. The mean age of victims at onset of abuse was 12.2 years (SD 3.3). The number of cases increased markedly after age of 1 1 years and there was a small peak in the age range 5-7 years. The mean age at onset of abuse in intrafamilial victims was 9.8 years (SD 3.9). They were considerably younger than extrafamilial abused victims (12.6 years, SD 3.0) (t= -3.65, p