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Journal of Child Custody

ISSN: 1537-9418 (Print) 1537-940X (Online) Journal homepage: http://www.tandfonline.com/loi/wjcc20

A comparison of attributions, self-esteem, anxiety,and parental attachment in sexually abused andnon-abused Korean children

Kyung-shick Choi, Elizabeth Englander, Yongki Woo, Jisun Choi, Ji-eun Kim &Hyejung Kim

To cite this article: Kyung-shick Choi, Elizabeth Englander, Yongki Woo, Jisun Choi, Ji-eunKim & Hyejung Kim (2016): A comparison of attributions, self-esteem, anxiety, and parentalattachment in sexually abused and non-abused Korean children, Journal of Child Custody

To link to this article: http://dx.doi.org/10.1080/15379418.2016.1164650

Accepted author version posted online: 17Mar 2016.

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1

A Comparison of Attributions, Self-Esteem, Anxiety, and

Parental Attachment in Sexually Abused and Non-Abused

Korean Children

Kyung-shick Choi

Department of Criminal Justice, Bridgewater State University, Bridgewater, MA, USA

Elizabeth Englander

Department of Psychology, Bridgewater State University, Bridgewater, MA, USA

Yongki Woo

Department of Criminal Justice, Washington State University, Pullman, WA, USA

Jisun Choi

Department of Criminal Justice, John Jay College, New York, NY, USA

Ji-eun Kim

Department of Forensic Nursing, Daegu Child Sexual Abuse Response Center, Daegu, South

Korea

Hyejung Kim

Department of Psychology, Catholic University of Daegu, Daegu, South Korea

Address correspondence to Kyung-shick Choi, Department of Criminal Justice, Bridgewater

State University, Bridgewater, MA 01235. E-mail: kchoi@bridgew.edu

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Abstract

This study attempts to address the dearth of information about child sexual abuse (CSA) and

psychological functioning in Korean children by measuring the psychological impact of sexual

abuse on children in South Korea. The original data were collected on 92 sexually abused children

(age 13 or younger) who underwent medical forensic interviews and psychological evaluations

prior to treatment. This study collected additional data reflecting specific psychological

evaluations from a control group drawn from five randomly chosen elementary schools. The

psychological impact on the group of sexually abused children was compared to the control group

via the assessment of four major psychological diagnostic criteria: (1) CAPS (Child Attribution

Perception Scale), (2) SES (Self-Esteem Scale), (3) PBS (Parental Behavior Scale-Child

Reporting), and (4) STAI-C (State Trait Anxiety Inventory-Children). Using structural equation

modeling, the findings indicated that the abused and control-group children differed significantly

on these four psychological criteria. Policy recommendations addressing victim, parent, and health

provider needs are reviewed.

Keywords: child attribution perception, child state trait anxiety, childhood sexual abuse, Korean,

parental behavior, self-esteem

Childhood sexual abuse (CSA) is not confined to any particular culture or place. According

to the U.S. Department of Health & Human Services (2009), there were approximately 60,000

confirmed cases of CSA in the U.S. in 2007. In South Korea, as in the United States, the sexual

abuse of children has been a serious category of sex crime.

In all cultures, CSA is a challenging topic of study. First, the preponderance of data comes

from western countries, limiting generalizability of findings. This is important not only because of

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possible variations in frequency, but also because any type of sexual offending is complicated by

local cultural mores about sexuality, candor about victimization, and childrearing. In data coming

from western countries, females consistently report more abuse, and in many cases only females

are the subjects of study by researchers (Alvy, Hughes, Kristjanson, & Wilsnack, 2013; Browne

& Finkelhor, 1986; Ramirez & Milan, 2016). Such studies report higher rates of CSA when

compared with their mixed-gender counterparts.

Defining CSA is also more complex than meets the eye. For example, subjects may fail to

identify sexual abuse as abuse per se. In trying to avoid such subjective interpretations of CSA,

researchers rely on officially-detected cases, which seem likely to be qualitatively distinct from

undetected cases. Some research has only examined cases of CSA where physical contact has

taken place, while others have included study of psychological forms of CSA (e.g., showing a

child pornographic videos).

What does seem relatively consistent is the large number of evidence-based studies that

have reported an association between CSA and a variety of psychological difficulties during

childhood and in later life (Allen, Thorn, & Gully, 2015; Berman & Knight, 2015; Day, Thurlow,

& Woolliscroft, 2003; Hornor, 2009). A meta-analysis of 38 studies in 1996 showed that CSA is

associated with anxiety, anger, depression, sexual re-victimization, impairment of self-esteem,

self-harm, sexual problems, greater substance abuse, suicidality, interpersonal and behavioral

problems, and post-traumatic stress responses (Neumann, Houskamp, Pollock, & Briere, 1996).

Overall, though, despite the reliability of this literature (which suggests such a strong need

for local research and intervention), data from Asia is lacking. Cultural factors in that region of the

world may suppress reporting and subject candor, thus hampering any systematic research of CSA.

South Korea is no exception. The exact effects of CSA in South Korea have not been deeply

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explored due to limited access to victims (rendering researchers unable to complete psychological

evaluations), and the cultural belief that CSA incidents are shameful and should not be openly

discussed. Yet a recent report from the Supreme Prosecutor’s Office in South Korea (2011)

disclosed that reports of child sexual abuse incidents have dramatically increased (by about 80%)

between 2002 and 2011. It is not clear if this phenomenon has been caused by increased reporting,

increased recognition of the seriousness of child sexual abuse among the public, or a change of

policing strategy to focus more on sex crimes. Despite this increased attention by mass media and

growing public concern about child sexual abuse, little empirical research has been conducted in

South Korea. While some (not a lot) has focused on other Asian populations (e.g., China), Asian

cultures are not homogenous and there is no reason to automatically assume that such research

applies equally to Korean samples.

The aim of this study is to address this gap in the literature by measuring the psychological

impact of sexual abuse on a sample of abused children in South Korea and to identify possible

policy implications. In this case, we were able to gain sufficient access to victims and controls to

directly measure psychological functioning. By employing data comparing 92 sexually abused

Korean children and 351 non-offending children, the current research examines whether sexually

abused children differ from the comparison group in terms of four main psychological diagnostic

criteria: (1) CAPS (Child Attribution Perception Scale), (2) SES (Self-Esteem Scale), (3) PBS

(Parental Behavior Scale-Child Reporting), and (4) STAI-C (State Trait Anxiety Inventory-

Children). Using structural equation modeling (SEM), latent mean analysis (LMA) was conducted

to assess between-group differences on the four main psychological diagnostic criteria. A better

understanding of the psychological conditions of Korean victims might help improve their quality

of life by enhancing effective treatment policies and practices for victims of sexual assault.

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LITERATURE REVIEW

A Variety of Effects of Sexual Abuse on Children

Despite the lack of agreement about a precise definition of CSA, no one contests that being

sexually abused leads to a variety of negative impacts on the victim, and that CSA should be

seriously examined in both clinical and academic research fields (Heim, Newport, Mletzko, Miller,

& Nemeroff, 2008; Paolucci, Genuis, & Violato, 2001; Paul, Cantania, Pollack, & Stall, 2001;

Tomeo, Templer, Anderson, & Kotler, 2001; Walker, Hernandez, & Davey, 2012). Yet it is also

true that despite the strong associations observed between CSA and symptomatology, variability

in symptoms and in the success of therapy seems to be the norm, rather than the exception. This

study will examine two of the most frequently-noted symptoms following CSA: self-esteem and

anxiety (Browne & Finkelhor, 1986; Rao, DiClemente, & Ponton, 1992), as well as two of the

factors that appear to significantly impact the success of psychotherapeutic interventions seeking

to address CSA: attributions and parental behaviors (Valle & Silovsky, 2002). A great deal of

research has already examined these factors, but they remain largely unstudied in Korean samples.

While some research does examine Asian populations, it is important to note that these populations

may be similar but should not be assumed to be culturally homogenous. This study begins to

address the gap in the literature by examining the associations between these factors and CSA in

a Korean sample of children.

Attributions and CSA

Overall, the association between negative self-attributions and CSA has been well-

established (Browne & Finkelhor, 1986; Cantón-Cortés, Cantón, & Cortés, 2012; Daigneault,

Hébert, & Tourigny, 2006; Daigneault, Tourigny, & Hébert, 2006; Steel, Sanna, Hammond,

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Whipple, & Cross, 2004). A sexual abuse victim’s tendency to hold themselves responsible for the

abuse, their hostile attributional bias regarding the dangerousness of the world, and a generally

pessimistic style have all been noted to impede recovery following abuse (Valle & Silovsky, 2002).

Blaming one’s self (versus blaming the abuser) is associated with internalizing problems (i.e.,

mood disorders), whereas subjects who blame others have more problems in their interpersonal

relationships (externalizing difficulties; Valle & Silovsky, 2002). Simply not being believed – or

attributing the behavior of others to the idea that one is not being believed – is also associated with

a poor adjustment in subsequent psychotherapy (Cohen & Mannarino, 2000). Viewing the world

as a dangerous place, a tendency noted in victims of CSA, is associated with both internalizing

and externalizing problems (Valle & Silovsky, 2002).

There are very few studies of attributions and CSA among Asian samples, despite calls for

more research (Joo, 2015). One study of female college students found that Asian students

attributed more blame and responsibility to women for sexual assault (Lee, 2005). Another study

of South Asian students found that those who adhered to “Model Minority” beliefs were more

likely to also believe myths about CSA, including the myth that the Asian culture protects

individuals against CSA (Kanukollu, 2010). Others have also noted the same myth in samples of

Asian-Americans (Wong, 1987). A case study of one CSA victim, a South Asian woman living in

Canada, concluded that her cultural beliefs interfered with her recovery (Best, 1989). A study

comparing Asian-American CSA victims with victims from other ethnic groups found that Asian-

American mothers of victims were more likely to disbelieve reports of abuse, less likely to report

abuse to authorities, and less likely to complete treatment (Rao et al., 1992). The concepts of shame

and “loss of face” in Asian cultures suggest that admitting sexual abuse may bring shame upon

both the victim and their entire family and community (Back et al., 2003; Futa et al., 2006). These

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studies all suggest that attribution research on American and European samples may not readily

apply to Korean victims, and because attributions are so strongly associated with recovery from

CSA, more research on Korean populations is clearly needed. Indeed, a recent in-depth review of

programs in South Korea noted that programs for all stakeholders (children, parents, educators,

physicians) are all in very short supply (Lee, Lee, & Baek, 2014).

Parenting Characteristics: Attachment

The concept of parent-child attachment refers to the emotional security of the bond between

a child and his or her caregivers (Ainsworth & Bowlby, 1991; Berman & Knight, 2015). An

insecure attachment can be the result of many factors, including parent or child psychopathology,

situational stressors, or the actions of others (Bretherton, 1995). Attachment problems are often

related to other parental caregiving failures, such as neglect, child abuse, and inability to care for

offspring (Kisiel et al., 2014). A large research literature has confirmed the impact that attachment

has upon a child’s development and behaviors (Scott, Briskman, Woolgar, Humayun, &

O’Connor, 2011).

Attachment and its relationship to CSA has been examined now for several decades, and

the attachment a child has to a parent appears to be less secure in families where sexual abuse

occurs; in addition, the attachment itself is related to the symptoms experienced by the victim

(Alexander, 1992). One study compared securely attached and insecurely attached child victims

of abuse, and found that the securely attached victims exhibited fewer behavior problems (Lowell,

2011). When the non-abusing parent was more securely attached, the adult relationship outcomes

for the victims of CSA improved (Godbout, Briere, Sabourin, & Lussier, 2014). In a sample of

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abused women, attachment was related to shame and the perceptual attributions they made about

the abuse (Tomas-Tolentino, 2010).

Factors that may interfere with a secure attachment are also, themselves, associated with

sexual abuse. Children from less cohesive, separated, or divorced families; poor families; or

families with a history of poor health and/or substance abuse are more likely to be victims of sexual

abuse (Fergusson, Lynskey, & Horwood, 1996; Ramírez, Pinzón-Rondón, & Botero, 2011;

Woodward, Fergusson, & Horwood, 2001). Children who live apart from their mother at some

time may be more likely to be sexually abused (Bagley & Ramsay, 1986; Finkelhor, 1984; Herman

& Hirschman, 1981). Additionally, children with an ill or disabled parent are at increased risk of

being sexually abused (Finkelhor, 1984; Herman & Hirschman, 1981; Mullen, Martin, Anderson,

Romans, & Herbison, 1994, 1996). Unfortunately, programs addressing prevention and

intervention of CSA often fail to account for family situations and parental attachment, despite

findings that demonstrate that maternal responses that convey protection and support are

associated with victims' improved mental health and social functioning (Lovett, 2004).

Patriarchal styles of parenting, which de-emphasize attachment and place primary

importance on obedience and filial piety (the tradition that one must respect and care for one’s

parents), have also been associated with CSA. Filial piety has been studied in Korean society as

well as in other Asian cultures (Back et al., 2003; Sung, 1995). A patriarchal parenting style

predicted a positive history of unwanted sexual attention in a sample of college students (Whealin,

Davies, Shaffer, Jackson, & Love, 2002). Women in Asian families with cultural beliefs that

emphasize male dominance and patriarchy may be at increased risk for sexual abuse and violence

(Hall, Windover, & Maramba, 1998).

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Some research on parenting styles and CSA has been conducted on Asian samples, and one

study did speculate that lower rates of abuse in China may be due to a family structure that included

higher levels of family supervision, relative to western cultures (Back et al., 2003; Sun, Dunne,

Hou, & Xu, 2013). Other research has specifically examined attachment and CSA in non-European

or -American samples. Insecure parental attachment was related to child sexual abuse in Iranian

boys (Mikaeili, Barahmand, & Abdi, 2013). Data from Asian victims of CSA suggests that they

may come from families characterized by less secure attachment compared to their western

counterparts (Ji, Finkelhor, & Dunne, 2013; Rao et al., 1992).

Psychological Effects of CSA: Anxiety and Self-Esteem

Overall, previous research has described and has empirically shown the negative

psychological effects of sexual abuse on children, such as self-esteem issues, major depression,

aggression, and relationship problems (Krause & Roth, 2011). A robust research literature has

demonstrated that sexually abused children show a variety of negative short- and long-term

emotional, psychological, and behavioral problems over the course of their life (Berman & Knight,

2015; Meyerson, Long, Miranda, & Marx, 2002; Peters, 2001). Specifically, researchers have

found that children who are victims of sexual abuse report greater depression, more general

psychological distress, more conduct problems and aggression, lower self-esteem, poorer school

performance, and more substance abuse problems (Bagley & Ramsay, 1986; Barnes, Noll, Putnam,

& Trickett, 2009; Briere & Elliott, 2003; Brown, Cohen, Johnson, & Smailes, 1999; Filipas &

Ullman, 2006; Friedman et al., 2011; Garnefski & Arends, 1998; Hornor, 2009; Kendall-Tackett

& Watson, 1991). For example, using a random sample of 387 Canadian women, Bagley and

Ramsay (1985) found that sexually abused women have more instances of depression than women

who were not. Several studies examining sexual behavior in CSA victims have noted that they are

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more likely to become involved in a variety of sexual activities, such as multiple sexual

partnerships, teenage pregnancy, and sexually transmitted infections (Littleton, Breitkopf, &

Berenson, 2007; Mason, Zimmerman, & Evans, 1998; Putnam, 2003; van Roode, Dickson,

Herbison, & Paul, 2009; Steel & Herlitz, 2005).

Both internalizing and externalizing symptomatology has been noted in victims of CSA.

According to Tsun-Yin (1998), victims of abuse are less likely to build up a sense of trust and

confidence in relationships with others over their lives. They also do not tend to develop self-

concept or self-esteem appropriately (Krause & Roth, 2011). Additionally, Cole and Putnam

(1992) explain that physical and psychological problems, including identity confusion, lower self-

esteem, self-destructive sign, unstable relationships, suspiciousness, lack of intimacy, loneliness,

and poor impulse control have been found in sexually abused children. Additionally, a longitudinal

study on a cohort of subjects in New Zealand found that CSA prior to age 16 was associated with

poor self-esteem at age 30 (Fergusson, McLeod, & Horwood, 2013).

Anxiety was found to be one of the most frequent symptoms noted in adult survivors of

sexual abuse in a longitudinal study (Fergusson et al., 2013), and the most frequent psychological

symptom reported by both Asian and non-Asian patients in a clinical sample of reported CSA

victims (Rao et al., 1992). Rao et al. (1992) also found that Asian-Americans in the sample were

no more likely to report anxiety, although they were less likely to act out inappropriately and more

likely to admit to suicidal ideation and attempts.

Research on Asian Populations

The association between the factors examined in this study and CSA is not controversial

(Stoltenborg, van IJzendoorn, Euser, & Bakermans-Kranenburg, 2011). But as noted above,

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relatively less research exists that specifically examines the factors of attribution, parenting, self-

esteem, and anxiety in Korean victims of CSA. Prevalence estimates do suggest that in Asian

countries, such as China, rates of CSA may be lower than in America or Europe, although the

evidence for this difference is described as equivocal and more research is needed (Finkelhor, Ji,

Mikton, & Dunne, 2013; Ji et al., 2013; Stoltenborg et al., 2011). Still, research on other Asian

countries remains largely uncompleted and data on the factors examined in this study, particularly

on Korean populations, has been less explored (Back et al., 2003; Joo, 2015). Given the important

implications for prevention programs and therapeutic treatment after CSA, it is imperative that

culture-specific research be conducted.

METHODS

Current Study

Research Hypotheses

The purpose of this study is to measure the psychological impact of being sexually abused

on a sample of Korean children and to suggest possible policy implications. The research

hypothesis for this study is simple. By comparing 92 sexually abused Korean children with a

comparison group, the current study hypothesizes that Korean sexually abused children differ

psychologically from Korean children who are not sexually abused. More specifically, we

hypothesize that sexually abused children will differ from non-sexually abused children on these

factors: child attribution perception, self-esteem, parental attachment, and state trait anxiety. Based

on previous research on child sexual abuse, four hypotheses were clearly established. Hypotheses

for this study are as follows:

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1. Child attribution perceptions will differ between sexually abused children and a

comparison group.

2. Sexually abused children are likely to have lower self-esteem than the comparison group

children.

3. Sexually abused children are less likely to report secure attachment to their parents, relative

to a comparison group.

4. Sexually abused children are likely to have higher state trait anxiety than the comparison

group children.

Sample and Data Collection

The original data were collected from 92 sexually abused children during a 24-month

period from October 2007 to September 2009 in a center for the prevention of child sexual abuse

located in southeastern Korea (Choi et al., 2015). The children received medical forensic

interviews and psychological evaluations prior to treatment. This study also collected additional

data from a control group (N = 351) derived from five randomly assigned elementary schools, and

reflecting specific psychological evaluations.

Table 1 presents sample descriptive statistics. A total of 443 children participated in this

study, and the demographic characteristics of the comparison groups are presented. The proportion

of males to females in the control group was almost equal; however, there were many more females

in the victim group. Furthermore, respondents' answers to the question about parents’ marital status

revealed that while only 2% of the control group’s parents were divorced, over 28% of the victim

group’s parents were divorced. This difference may be associated with a lack of parental

supervision and financial difficulties, both of which can be related to a variety of opportunities for

criminal victimization, including sexual abuse.

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Measurement

Measurement for Psychological Evaluation

The main psychological diagnostic criteria in this study consist of four subscales: (1) Child

Attribution Perception Scale (CAPS), (2) Self-Esteem Scale (SES), (3) Parental Behavior Scale-

Child Reporting (PBS), and (4) State Trait Anxiety Inventory-Children (STAI-C).

Child Attribution Perception Scale (CAPS). Child Attribution Perception Scale (CAPS)

proposed by Mannarino, Cohen, and Berman (1994) is used in this study. This Scale was developed

to specifically measure abuse-related attributions and perceptions (Mannarino et al., 1994). It is an

18-item scale that consists of four categories of measurements: feeling different from peers (items

1–4), personal attribution for negative events (items 5–8), perceived credibility (items 9–13), and

interpersonal trust (items 14–18). As a result of analysis of skewness and kurtosis for both

experimental and comparison groups, however, a number of items, except six items (1, 2, 3, 12,

14, 17), do not satisfy the criteria of skewness (<2) and kurtosis (<4) for SEM (Hong et al., 2003).

Except for these six items, five items were chosen for this analysis. These items included: (1)

People seem to treat me as an older person; (2) I seem to different from friends around me; (3)

From experience I have learned that people suspect what I said (they thought I was lying); (4) It is

hard to believe people who are not my friend; and (5) It seems dangerous to believe other people.

Responses were coded from 1 (strongly disagree) to 5 (strongly agree) on a five-point Likert scale,

which means a higher score reflected a higher level of perceived negative attitudes toward oneself.

The standardized reliability coefficients were reasonably acceptable (α = .72).

Self-Esteem Scale (SES). The self-esteem measure used in this study consists of five of the

ten items of the Rosenberg Self-Esteem Scale (Carmines & Zeller, 1979; Rosenberg, 1986, 1989).

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These items included: (1) I am a person of worth; (2) I think that I have a number of good qualities;

(3) I am able to do things as well as most other people; (4) I have a positive attitude about myself;

and (5) On the whole, I am satisfied with myself. The response categories for these items were a

4-point Likert scale with 1 = strongly disagree to 4 = strongly agree. This meant that respondents

who scored high on the scale had the highest levels of self-esteem. The standardized reliability

coefficients were highly acceptable (α = .89).

PBS (Parental Behavior Scale-Child Reporting). The PBS Scale consists of 33 survey

items with a series of Likert scales asking the respondents to indicate parenting attitude. The PBS

Scale has three subcategories of measures: Reception and refusal (items 1–11), autonomy and

control (items 12–22), and excessive expectation and non-excessive expectation (items 23–33).

Among these three categories, the reception and refusal category is employed to measure rearing

attitudes of parents toward the children. Each five items (1, 2, 3, 4, and 5) out of eleven items of

reception and refusal for mother and father were selected for this analysis. These items were

included: (1) My parents usually know my friends whom I am familiar with; (2) I and my parents

understand each other; (3) My parents always try to understand what I think while we are talking;

(4) When I seem to have a difficulty or a concern, my parents recognize the causes; and (5) When

I talk to my parents, they recognize my feelings and my mind. The response categories for these

items were a 4-point scale with 0 = Never, 1 = Rarely, 2 = Often, and 3 = Always. This indicates

that respondents who scored high on the scale had higher attachment to their parents. The

standardized reliability coefficients for both father (α = .88) and mother (α = .86) PBS were highly

acceptable.

State Trait Anxiety Inventory (STAI-C). The State Trait Anxiety Inventory was constructed

with twenty survey items that comprise each of the common anxiety traits (Anxiety Trait) and

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present emotional anxiety scales (State Anxiety). In this study, the common anxiety traits are used.

Respondents were asked to indicate the frequency of events through three possible responses that

reflected each statement. Among these 20 items of anxiety traits, five items were selected for this

analysis. These items included: (1) I feel that I am miserable; (2) I have a lot of worries; (3) Useless

thoughts bother me; (4) I have fear(s) that other people are not aware of (do not know); and (5) I

worry about what is going to happen to me. The response categories for these items were a three-

point scale: 1 = Rarely happened, 2 = Sometimes happened, and 3 = Often happened. This

indicates that respondents who scored high on the scale had higher levels of anxiety. The

standardized reliability coefficients for anxiety trait were quite acceptable (α = .81).

Statistical Analyses

Latent Mean Analysis

To study group differences in psychological impact on sexual abuse, LMA using SEM was

performed. Latent Mean Analysis (LMA) is a method to assess between-group differences based

on structural equation modeling (SEM). It examines mean difference across the samples through

latent variables that consider measurement error. Because latent variables are not associated with

measurement error, LMA is more likely to find between-group differences than the traditional

statistical methods (Hong, Malik, & Lee, 2003). Thus, LMA provides a powerful alternative to

traditional statistical techniques when the variables of interest are latent constructs.

Group differences in the means of latent variables can be estimated only if the latent

variables are on the same scale in all groups. Thus, testing LMA requires three conditions:

configural invariance, metric invariance, and scalar invariance across the groups. Configural

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invariance, metric invariance, and scalar invariance were examined in the hierarchical order based

on several model fit indexes.1

RESULTS

Descriptive Statistics

Based on a number of prior studies on sexual child abuse, critical psychological diagnostic

criteria are contained in the statistical analysis. Means and standard deviation (SD) scores for both

comparison group and experimental group are presented in Table 2.

Table 3 presents the correlation matrix, skewness, and kurtosis values for the five

composite variables for both comparison groups. The principle of normality is one of the important

assumptions for using structural equation modeling. However, the maximum likelihood estimation

procedures used in this study can yield biased outcomes when the normality assumption is violated

1 To evaluate the invariance tests, model-fit indexes were used. Typically, NNFI, CFI, and

RMSEA were recommended (Hong, 2000) because these models fit the index generally and

satisfy in sensitivity to sample size, the parsimony principle, and the criterion of clear

interpretation for analysis. According to Browne and Cudeck (1993), a rule of thumb is that

RMSEA ≤ .05 indicates close approximate fit, values between .05 and .08 suggest reasonable

error of approximation, and RMSEA ≥ .10 suggests poor fit (Kline, 2005). TLI (NNFI;

Bentler & Bonett, 1980) and CFI ≥ .90 indicates close approximate fit (Bentler, 1990; Tucker

& Lewis, 1973). For this study, however, CFI was not measured in multigroup analyses

because it does not consider model complexity (Hong et al., 2003).

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(Curran, West, & Finch, 1996). Thus, each composite variable of skewness and kurtosis were

examined. Both treatment and comparison groups show the similar association with each variable.

Regarding sexually abused children, CAPS shows the positive relationship with STAI-C while

SES and PBS are positively correlated. One interesting finding is that PBS-mother shows the weak

and negative association with STAI-C, while PBS-father presents the strong and negative

relationship with STAI-C. With regard to the comparison group, on the other hand, all variables

show the statistically significant for correlation. Specifically, CAPS, SES, and PBS are negatively

correlated, whereas SES and STAI-C are negatively associated.

Test of Invariance

Multiple sample analyses were performed and maximum likelihood (ML) estimation

method was applied based upon a covariance matrix (Hong et al., 2003). Based on several model

fit indexes, configural invariance, metric invariance, and scalar invariance were examined along

with the hierarchical ordering of nested models.

Table 4 presents the model fit for each invariance test. When evaluating each model, χ2

statistic and its degrees of freedom should be examined whether the model fits the data across

groups (Hong et al., 2003). When χ2 difference was statistically insignificant between the adjacent

models, invariance tests are supported. As shown in Table 4, the chi-square (χ2) value and degrees

of freedom (df) for the baseline model (Model 1) are 422.341 and 226 at P < .001. Between the

model 1 and model 2, the χ2 value increased from 422.341 to 444.193 with adding 13 degrees of

freedom. These results showed that the χ2 difference was statistically insignificant (χ2 (13,

N = 443) = 21.852), so metric invariance was supported. Although the chi-square (χ2) difference

between model 2 and model 3 was statistically significant (χ2 (17, N = 443) = 70.132), scalar

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invariance (model 3) was satisfactory because the RMSEA and NNFI values had a little change

(TLI = .016, RMSEA = .004). As such, the RMSEA and NNFI values slightly changed between

the model 3 and the model 4 (TLI = .006, RMSEA = .001); thus factor variance invariance

(model 4) was supported. Consequently, observed mean differences can be considered as a

reflection of the real variations across groups.

Test of Latent Mean Differences

Because the assumptions of configural, metric and scalar invariance were satisfied, in this

step, the group differences in latent means were tested. According to Aiken, Stein, and Bentler

(1994), a certain constant value of unity as an independent variable can estimate means of latent

constructs for each of the constructs in LMA. According to Hancock (1997), it is impossible to

estimate the mean of a latent variable directly in LMA. However, the difference between the means

of a construct across groups can be measured through manipulating one of the construct means to

zero (Hong et al., 2003). In this study, the comparison group was selected as the reference group

with its latent mean parameters (β) fixed at zero.

Figure 1 presents the path diagrams for latent mean analysis. By fixing the latent means in

the reference group (non-offending group) to be zero, the latent means in the other group, sexually

abused children group in this study, are able to estimate to see if the latent mean estimates differ

significantly across groups (Marsh & Grayson, 1990). The constant value of unity is expressed a

square in Figure 1, and it has an effect on each of the factors and observed variables (Hong et al.,

2003). In the Figure 1, the values of β1, β2, β3, and β4 were estimated for the sexually abused

children group, while these values were constrained to be zero for the reference group (non-

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offending group). In short, the expected values of β1, β2, β3, and β4 in the sexually abused children

group reveal the mean differences in the latent constructs between the two groups.

Table 5 shows latent mean parameter estimates. Results present significance of the

difference between the means of the two groups on four main psychological diagnostic criteria.

Particularly, the comparison group’s mean was higher than that of the sexually abused children

group’s by 0.46 concerning SES and by 0.60 respecting PBS, whereas sexually abused children

group’s mean was higher than that of the comparison group’s by 0.45 regarding CAPS and by 0.13

with respect to STAI-T.

Finally, the magnitudes of the latent mean differences across groups were examined.

Cohen’s d effect size (Cohen, 1988) is generally used to change the latent mean differences to a

normal metric (Hong et al., 2003). The common standard deviation can be used if the hypothesis

of homogeneity of variance across groups is satisfied. When compared to Models 3 and 4 through

χ2 difference, NNFI, RMSEA, the homogeneity of variance assumption was accepted (see Table

4). Thus, the Cohen’s d was employed using the common standard deviations (Hong et al., 2003).

While the values of Cohen’s d for STAI-T were .25, which is considered as small, the values of

Cohen’s d for PBS were .75, which is judged as large effect size based on Cohen’s (1988)

guidelines. The computed values of d for CAPS and SES were .59 and .58, which are regarded as

middle. In short, it seems that there are some differences between sexually abused children and the

comparison children in terms of four diagnostic psychological criteria. In conclusion, these results

support the hypotheses that the children being sexually abused differ from the non-offending

children group in terms of mean differences in self-esteem, parental behavior, child attribution

perception, and child state trait anxiety.

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DISCUSSION AND CONCLUSION

This study compared 92 sexually abused children with 351 children in a comparison group

on four psychological criteria. All subjects were Korean, a group that has been inadequately

examined in the literature. We hypothesized that Korean children would be similar to their western

peers in that child attribution perception, self-esteem, parental behavior, and state trait anxiety

would differ between the comparison groups. Our hypotheses were supported.

CAPS scores (attributions) were positively associated with STAI-T (anxiety), while SES

(self-esteem) and PBS (parental attachment) were negatively related to attributions for both the

experimental and comparison groups. Moreover, latent mean analysis was conducted to examine

the extent to which the value of model parameter estimates differs across groups, and the findings

show that sexually abused Korean children differ from the comparison group on the four

psychological constructs. When comparing Cohen’s d across the four psychological diagnostic

criteria, the values of Cohen’s d for PBS were the largest. Overall, our findings generally support

both previous studies and research hypotheses on other populations.

Policy and procedure recommendations must address two issues: first, prevention through

education and awareness about child sexual abuse; and second, improving the Korean medical

community’s ability to treat CSA victims by understanding the importance of issues such as

attributions, self-esteem, and anxiety. Prevention through education could reasonably focus on

several different sectors of the Korean population. First, the findings here support the

implementation of parental and caregiver education programs. Understanding that parental

attachment is related to CSA underscores how important it is for caregivers to assess their own

attachment to their children, as a way of preventing and detecting child sexual abuse (Choi et al.,

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2015). Programs could help increase parental awareness of the link between the quality of their

attachment to their offspring and the child’s development, including his or her vulnerability to

CSA (Fergusson, Lynskey, & Horwood, 1996).

In addition, parental education about child sexual abuse is essentially needed. At present,

accurate and appropriate information about child sexual abuse is not readily available to Korean

parents and is rarely discussed between parents and their children (Kenny, Capri, Thakkar-Kolar,

Ryan, & Runyon, 2008). The fact that most CSA in this study (80%) was detected by direct

caregivers (mothers and teachers), suggests that if more such caregivers were educated about and

aware of CSA, detection rates would probably improve (Choi et al., 2015). Community programs,

with their broader reach, can operate to educate parents and other childcare stakeholders about

parenting and child sexual abuse. In Korean society, such community settings might include day

care settings, churches, libraries, community centers, and places for extracurricular activities (arts,

sports, etc.). The education of adults is important, since Korean society must not burden a child

victim with all the responsibility to speak out about the abuse; that may be beyond the control of

a victim, considering the violation of trust that is commonly associated with the victimization

(Choi et al., 2015). The National Sexual Violence Resource Center (2011) asserts that “the burden

of prevention should be distributed across community members, organizations, and social

structures. Changing the behavior of adults and communities, rather than the behavior of children,

is the ideal way to prevent child sexual abuse” (p. 3). Studies such as the one reported here can

help develop effective child sexual abuse prevention programs that integrate the concept of

parental attachment and awareness with reducing the possibility of child sexual abuse.

Policies that include the systematic education of children should also be implemented.

Since children in South Korea spend more hours in a school environment when compared to other

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nations, school-based programs are probably the most suitable option for the education of children

and school personnel. Researchers and educators could collaborate with local centers for child

sexual abuse in developing education programs, particularly in taking into consideration local

cultural norms and expectations. Research-based programs developed for western nations,

however, might be suitable for translation into Korean (Englander, 2013).

Finally, both “gateway” healthcare providers in Korea (e.g., pediatricians, family doctors)

and specialists in CSA require clear, easy-to-access information about how factors such as

attributions and self-esteem can impact post-CSA interventions. As technological communication

is so ubiquitous in South Korea, delivery mechanisms for information such as the findings noted

here can include different types of digital technology, including Internet publication. Online

materials for healthcare providers could be translated into Korean2.

There are several limitations to this study. It focused solely on Korean children, which

potentially limits its external validity. On the other hand, it should be noted that findings were

consistent with research on other populations. The second and third limitations are related to the

study’s design. Specifically, our sample size for sexually abused children was relatively small

compared to the comparison group. Also, the data used in this study was cross-sectional in nature.

These two limitations (sample size and cross-sectional data) impact our interpretations. Some of

the insignificant results in this study might be due to the small sample size and the cross-sectional

design. The cross-section nature of the data means that the causal relationship between sexual

abuse and its psychological impacts on children cannot be established. Although there are

differences between sexually abused children and the comparison group in terms of the four

2 http://marccenter.webs.com/physicians-nurses.

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psychological diagnostic criteria, we cannot be certain if the differences result from sexual abuse.

An alternative interpretation might suggest that children with certain psychological profiles are

more likely to be abused. Ultimately, longitudinal data is necessary to definitively understand the

effects of CSA on various aspects of sexual health and development.

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Table 1. Demographic variables (N = 443)

Variable Coding Experimental group

(n = 92)

Comparison group

(n = 351)

N % N %

Age (years) 5 1 1.1 – –

6 2 2.2 – –

7 9 9.8 – –

8 14 15.2 – –

9 16 17.4 – –

10 15 16.3 2 .6

11 15 16.3 50 14.2

12 17 18.5 73 20.8

13 3 3.3 225 64.1

Gender Male 21 22.8 168 47.9

Female 71 77.2 181 51.6

Family SES Upper N/A 41 11.7

Upper–middle N/A 111 31.6

Middle N/A 164 46.7

Middle-lower N/A 28 8.0

lower N/A 4 1.1

Parents’ marital

status

Married 54 58.7 334 95.2

Divorced 26 28.3 7 2.0

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Separated 5 5.4 4 1.1

Passed away 7 7.6 3 .9

Age at assault

(years)

4 1 1.1 – –

5 4 4.4 – –

6 7 7.8 – –

7 9 10.0 – –

8 10 11.1 – –

9 21 23.3 – –

10 14 15.6 – –

11 11 12.2 – –

12 12 13.3 – –

13 1 1.1 – –

Frequency of

assault

1 36 39.1 – –

2 7 7.6 – –

3 9 9.8 – –

4 4 4.3 – –

5 2 2.2 – –

6 1 1.1 – –

7 0 0 – –

8 1 1.1 – –

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9 5 5.4 – –

10 27 29.3 – –

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Table 2. Descriptive statistics for four major psychological diagnostic criteria

Variable Comparison group

(N = 351)

Experimental group

(N = 92)

M SD M SD

Child Attribution Perception Scale

(CAPS)

1.58 .65 2.03 .87

Self-Esteem Scale (SES) 2.91 .74 2.45 .84

Parental Behavior Scale (PBS)

Mother 3.15 .71 2.74 .86

Father 2.99 .77 2.19 .86

State Trait Anxiety Inventory (STAI-C)

Anxiety trait 1.38 .45 1.51 .57

Abbreviations: M = mean; SD = standard deviation.

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Table 3. Correlation, skewness, and kurtosis for treatment and comparison group

CAPS SES PBS_M PBS_F STAI-T

Treatment group (n = 92)

CAPS –

SES .200 –

PBS_M .145 .488** –

PBS_F .183 .370** .660** –

STAI-T .627** .275* .148 .337** –

Skewness .961 .107 .403 .416 1.042

Kurtosis .180 .866 .709 .687 .041

Comparison group (n = 351)

CAPS –

SES .338** –

PBS_M .293** .498** –

PBS_F .253** .420** .727** –

STAI-T .542** .358** .336** .299** –

Skewness 1.616 .249 .736 .471 1.358

Kurtosis 2.474 .523 .028 .675 1.519

*P < .05, **P < .01.

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Table 4. Fit indices for invariance tests

χ2 df TLI RMSEA

Model 1: Configural invariance 422.341 226 .910 .044

Model 2: Full metric invariance 444.193 239 .911 .044

Model 3: Full metric and full

scalar invariance

514.325 256 .895 .048

Model 4: Full metric, scalar, and

factor variance invariance

538.259 260 .889 .049

Note. TLI = Tucker-Lewis Index; RMSEA = root mean square error of approximation.

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Table 5. Result of latent mean analysis

Latent

Variables

Comparison group

(N = 351)

Sexually abused

children (N = 92)

Effect size

(Cohen’s d)

Grand mean

LM M LM M

CAPS 0 1.58 .233*** 2.03 .59 1.81

SES 0 2.91 .468*** 2.45 .58 2.68

PBS 0 2.07 .617*** 1.47 .75 1.77

STAI-T 0 1.38 .128* 1.51 .25 1.45

Note. LM = Latent Mean; M = Mean, *P < .05, **P < .01, ***P < .001.

The latent mean values for comparison group were set to zero.

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Figure 1. Path diagram for Latent Mean Analysis.

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