Abstract Aims Prevention of child maltreatment – incorporating physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence – is a clearly defined global policy priority. Global Burden of Disease studies have focused on estimating burden attributable to childhood sexual abuse omitting other forms of child maltreatment. This study aims to estimate burden attributable to child maltreatment using data from the first comprehensive national study, the Australian Child Maltreatment Study (ACMS), accounting for the co-occurrence of multiple forms, the complex impact of multi-type maltreatment and the contribution of interrelated factors. Methods We estimated burden attributable to child maltreatment by age and gender for Australia in 2021. Risk–outcome pairs that met criteria for sufficient evidence for a causal relationship were included. Relative risks were estimated as a function of exposure based on data from the ACMS incorporating increased risk with multi-type maltreatment and adjustment for confounding. Levels of exposure in each of the 32 mutually exclusive combinations or patterns of child maltreatment were estimated based on ACMS data by age and gender. The theoretical minimum risk exposure level was determined as no exposure to child maltreatment in the population and population attributable fractions (PAFs) were calculated. Attributable mortality, years of life lost, years lived with disability and disability-adjusted life years (DALYs) were estimated by multiplying PAFs by the relevant burden of disease estimates by age and gender for Australia in 2021. Sensitivity analyses were conducted to assess the robustness of the results. Uncertainty was propagated into attributable burden estimates using Monte Carlo simulation methods. Results Overall, child maltreatment accounted for 6.6% (95% uncertainty interval (UI), 6.2–6.9%) of all DALYs for women and 6.4% (95% UI, 6.0–6.7%) of all DALYs for men in Australia in 2021. An estimated 71.2% of self-harm, 57.1% of anxiety disorders and 49.3% of major depressive disorder (MDD) DALYs in women, and 63.8% of self-harm, 55.9% of anxiety disorders and 42.9% of MDD DALYs in men were attributable to child maltreatment. Conclusions Child maltreatment contributes to a substantial proportion of burden of disease in Australia, equivalent to leading lifestyle-related risk factors such as high body mass index, high blood pressure and smoking. This research significantly advances knowledge of the disease burden attributable to child maltreatment and provides novel methodology for measuring the impact of all five forms of child maltreatment combined on mental health and health risk behaviours nationally and globally.

BACKGROUND:Childhood experiences of domestic violence (EDV) are associated with short- and long-term adverse mental and physical health outcomes for victim-survivors; however, little is known about the health service utilisation among individuals with childhood EDV. OBJECTIVE:Examine associations between different forms of childhood EDV and health service utilisation. PARTICIPANTS AND SETTING:Data were drawn from the the Australian Child Maltreatment Study (n = 8503). METHODS:Associations between four forms of childhood EDV (physical violence, threats of harm, damage to property or pets, and intimidation or control) and past 12-month health service utilisation (hospitalisation, and consultation with seven health professionals) were analysed using survey-weighted logistic regression models. Estimates were calculated independently for each form of childhood EDV. Models were adjusted for each other form of EDV, four child maltreatment types, and socio-economic factors. Models were stratified by gender. RESULTS:Utilisation of mental health services (psychologists, psychiatrists and mental health nurses) were significantly more common among both women and men with childhood EDV compared to those without. The strongest associations were between any domestic violence and a primary care physician consultation (aOR = 1.49, 95% CI 1.25-1.78), and intimidation or control and a mental health professional consultation (aOR = 1.44, 95% CI 1.22-1.69), after full adjustment. Associations were typically stronger for men in the gender-stratified analyses. CONCLUSIONS:Childhood EDV significantly increases the likelihood of health service utilisation across the lifespan. Greater investment in domestic violence education and training for health professionals is needed.

BACKGROUND:Recent efforts to quantify any distinct impact of out-of-home care (OOHC) experience have encountered challenges in separating the effects of OOHC with the earlier maltreatment experiences given their strong association. This study investigates whether an OOHC experience uniquely affects the odds of meeting clinical threshold for four common mental disorders when matched with a non-care-experienced group on the intensity of their experience of child maltreatment. METHODS:Drawing on data from the Australian Child Maltreatment Study (ACMS), the present study aimed to minimize selection bias by using propensity score matching. The care-experienced (intervention; n = 395) and non-care-experienced (comparison; n = 395) groups were matched on key maltreatment characteristics including age of onset, duration, frequency, perpetrator type, type and range of maltreatment. Participants were aged between 16 and 65 + . RESULTS:Logistic regression showed that when adjusted for child maltreatment intensity, there was no significant effect of OOHC on any mental disorders. The odds ratio (OR) for experiencing each of the four mental health disorders explored were non-significant (OR = 0.8; 95 % CI = 0.4-1.7) indicating that care-experienced individuals were no more likely to experience any mental health disorder than non-care-experienced people once they were matched on the intensity of their childhood maltreatment experience. CONCLUSIONS:These results suggest that the key risk factor for mental disorders is the prior experience of child maltreatment and the intensity and characteristics of child maltreatment experiences in care-experienced populations. The findings highlight the importance of assessing child maltreatment intensity as a risk factor for poor mental health in care populations, rather than attributing these risks solely to the experience of being in OOHC.

BACKGROUND:Despite increasing awareness and understanding of children's victimisation through experiences of domestic violence (EDV), little attention has been given to the associated health outcomes. AIM:Examine associations between four different forms of childhood EDV (physical violence, threats of harm, property damage and intimidation or control) and four mental disorders and six health risk behaviours. METHOD:Data were drawn from the Australian Child Maltreatment Study. Associations were examined using survey-weighted logistic regression models. Estimates were calculated adjusting for each other form of EDV, as well as other types of child maltreatment and socio-economic factors. Each model was stratified for men and women. RESULTS:All mental disorders and health risk behaviours were more common among those with any childhood EDV compared to those without. Intimidation or control and damage to property or pets independently predicted most mental disorders and health risk behaviours. The strongest association was found between intimidation or control and post-traumatic stress disorder (adjusted odds ratio (aOR) 2.30, 95% CI 1.77-2.98) and generalised anxiety disorder (aOR 1.65, 95% CI 1.36-1.99), and damage to property or pets and severe alcohol use disorder (aOR 1.76, 95% CI 1.36-2.27). CONCLUSIONS:Childhood EDV characterised by intimidation or control and property damage or harm to pets significantly increases the risk of mental disorders and health risk behaviours in adulthood. Urgent investment is needed in child-centred and trauma- and family-violence-informed interventions that support children's recovery and stronger legal protections to prevent children from being weaponised in post-separation coercive control.

BACKGROUND:Child maltreatment (CM) poses a substantial health burden, but its impact on healthcare costs and productivity loss in Australia remains unclear. OBJECTIVE:To estimate the costs of health service use and productivity loss associated with CM in Australia. PARTICIPANTS:Cross-sectional data (N = 8503) from the Australian Child Maltreatment Study were analyzed to identify people with CM, their health service use, and employment status. METHODS:Hurdle models estimated in two parts, comprising logistic regression and generalized linear models, were used to estimate differences in health service use and average costs between those with and without CM. Unit costs of health services were sourced from national databases (e.g., Medicare Benefits Schedule). Productivity losses were estimated using the human capital approach. Sensitivity analyses were conducted to examine the robustness of findings. RESULTS:Annual healthcare costs for each individual with CM was A$1670 higher than those without CM. Incremental productivity losses due to unemployment averaged A$2750 per labor force participant with CM annually. The point estimates of these costs increased with the number of CM subtypes experienced and remained highest among those with any neglect, sexual, and emotional abuse. A notable portion of health service use costs was attributed to mental health services. Subgroup analyses also revealed higher health service use costs for females and individuals with diverse gender identities. Findings mostly remained robust across sensitivity analyses. At a population level, CM was associated with annual health service use costs of A$21.6 billion and productivity losses of A$24.1 billion. CONCLUSION:CM imposes substantial health service use and productivity costs in Australia. Targeted investment in prevention strategies is urgently needed.

OBJECTIVES:To estimate the prevalence in Australia of intimate partner violence, each intimate partner violence type, and multitype intimate partner violence, overall and by gender, age group, and sexual orientation. STUDY DESIGN:National survey; Composite Abuse Scale (Revised)-Short Form administered in mobile telephone interviews, as a component of the Australian Child Maltreatment Study. SETTING:Australia, 9 April - 11 October 2021. PARTICIPANTS:8503 people aged 16 years or older: 3500 aged 16-24 years and about 1000 each aged 25-34, 35-44, 45-54, 55-64, or 65 years or older. MAIN OUTCOME MEASURES:Proportions of participants who had ever been in an intimate partner relationship since the age of 16 years (overall, and by gender, age group, and sexual orientation) who reported ever experiencing intimate partner physical, sexual, or psychological violence. RESULTS:Survey data were available for 8503 eligible participants (14% of eligible persons contacted), of whom 7022 had been in intimate relationships. The prevalence of experiencing any intimate partner violence was 44.8% (95% confidence interval [CI], 43.3-46.2%); physical violence was reported by 29.1% (95% CI, 27.7-30.4%) of participants, sexual violence by 11.7% (95% CI, 10.8-12.7%), and psychological violence by 41.2% (95% CI, 39.8-42.6%). The prevalence of experiencing intimate partner violence was significantly higher among women (48.4%; 95% CI, 46.3-50.4%) than men (40.4%; 95% CI, 38.3-42.5%); the prevalence of physical, sexual, and psychological violence were also higher for women. The proportion of participants of diverse genders who reported experiencing intimate partner violence was high (62 of 88 participants; 69%; 95% CI, 55-83%). The proportion of non-heterosexual participants who reported experiencing intimate partner violence (70.2%; 95% CI, 65.7-74.7%) was larger than for those of heterosexual orientation (43.1%; 95% CI, 41.6-44.6%). More women (33.7%; 95% CI, 31.7-35.6%) than men (22.7%; 95% CI, 20.9-24.5%) reported multitype intimate partner violence. Larger proportions of participants aged 25-44 years (51.4%; 95% CI, 48.9-53.9%) or 16-24 years (48.4%, 95% CI, 46.1-50.6%) reported experiencing intimate partner violence than of participants aged 45 years or older (39.9%; 95% CI, 37.9-41.9%). CONCLUSIONS:Intimate partner violence is widespread in Australia. Women are significantly more likely than men to experience any intimate partner violence, each type of violence, and multitype intimate partner violence. A comprehensive national prevention policy is needed, and clinicians should be helped with recognising and responding to intimate partner violence.

Background National data on the prevalence and characteristics of childhood experiences of domestic violence (EDV), and its relationship with other types of childhood maltreatment and adversity are limited. This study provides the prevalence and characteristics of childhood EDV from a nationally representative sample of Australians aged 16-years and over. Methods Data were drawn from the Australian Child Maltreatment Study. Prevalence estimates and characteristics (age of onset and cessation, duration, frequency) of four forms of retrospectively reported childhood EDV (physical violence, threats of harm, property damage or harming pets, intimidation or control) by a parent against another parent, were calculated. Associations with four other types of child maltreatment (emotional, physical and sexual abuse, and neglect) were examined, and each model stratified by gender. Prevalence estimates of experiencing eight other adverse childhood experiences (ACEs) were calculated for those with and without childhood EDV. Results Of the 39.6% of participants reporting childhood EDV, one in five experienced all four forms. Intimidation or control occurred over more years, was more frequent and was more prevalent in mid-late adolescence compared to other forms of EDV, and was associated with the strongest odds for childhood emotional abuse (6-fold-odds for men; 3.3-fold-odds for women). All four other types of child maltreatment and all other ACEs (except parental death) were substantially more common among those with EDV compared to those without. Conclusions Childhood EDV presents an increased risk of other types of maltreatment and adversity in childhood. The findings emphasise the need to advance recognition of children as victims of domestic violence in their own right.

Background:Early detection of autoimmune psychosis (AP) mediated by antineuronal antibodies (Abs) is critical for achieving optimal clinical outcomes. However, evidence remains limited regarding who should be tested and how Ab-positive cases should be managed. In this large-scale study, we evaluated proposed clinical criteria for targeted Ab testing in psychiatric services and described the clinical course of seropositive patients. Methods:Individuals with early psychosis (EP) or persistent psychosis (PP) were prospectively assessed with clinical criteria to determine high- or low-risk status for AP. Blood samples were collected for Ab testing using a fixed cell-based assay. Seropositive individuals were invited for detailed review, including clinical, functional, and cognitive assessments at baseline and a 12-month follow-up. Blood samples were collected from 754 individuals (EP: n = 352, PP: n = 402). Results:Abs were present in 2.3% (17/754), including 3.4% (12/352) of patients with EP and 1.2% (5/402) of patients with PP. AP was confirmed in 2 cerebrospinal fluid (CSF)-positive high-risk individuals (total: 2/754, 0.3%; EP: 1/352, 0.3%; PP: 1/402, 0.2%). Both improved with immunotherapy. Although some low-risk patients were seropositive, none were diagnosed clinically with AP. Conclusions:AP prevalence was low in this cohort. Targeted testing informed by clinical high-risk criteria successfully identified 2 immunotherapy-responsive AP cases. This approach appears feasible but requires further validation. People with psychosis and high-risk AP features should be considered for Ab testing in sera and CSF where indicated. Further research is required to embed targeted Ab testing into mental health services.

Communication is recognised as crucial to culturally safe healthcare, and poor communication remains a major reason that Aboriginal and Torres Strait Islander people do not access healthcare. This pragmatic, pre-post comparison study employed mixed methods to evaluate cultural capability and clinical yarning training delivered to 57 clinicians supporting Aboriginal and Torres Strait Islander people at three persistent pain management services in Queensland, Australia. Observable outcomes of the training were evaluated by video recording clinicians’ training experiences and seven consultations with patients that occurred either pre- or post-training. Reported outcomes were evaluated by using a modified Cultural Safety Survey (CSS), which was completed by 67 patients during a period pre- and post-training delivered to the clinicians. Using conversation analysis methods and focusing on clinicians recorded both pre- and post-training, analysis of video recordings identified observable differences in communication practices that were consistent with learning opportunities in the training. Statistical analysis of the CSS survey focused on subsamples of data from 20 patients who consulted clinicians who attended training. A comparison of pre- and post-training data and found no difference in the overall score of the CSS (p=0.594). The study identified differences in social practices following training but did not find changes to patient experiences of care. These findings demonstrate the feasibility of changing clinical communication in relation to culture, while also highlighting the importance of examining practices used in social interaction to determine whether and how training is applied by learners.

To examine the population prevalence of bullying victimization by peers and siblings reported in a nationally-representative sample of Australian adults. Australians 16 years and older participated in a computer-assisted telephone interview survey (N = 8503) and answered questions about childhood bullying victimization perpetrated by peers and siblings. For peer bullying victimization, they were also asked about the duration of their experiences, and experiences of bias-based bullying victimization (i.e., bullying targeting identity characteristics). Overall, 28.7

Introduction:Exercise can improve the quality of life (QoL) of people with severe mental illness (SMI); however, many experience practical, psychosocial, and socioeconomic barriers to commencing and maintaining exercise. This protocol describes a study aiming to assess the effectiveness of an Accredited Exercise Physiologist (AEP) service for improving QoL in adults with SMI. Methods and Analysis:This is a prospective non-randomised effectiveness trial to evaluate the effectiveness and cost-effectiveness of an AEP service within mental healthcare settings. Participants will be adults (18+ years) with SMI recruited from public mental health services and community organizations. The primary outcome is QoL assessed using the Recovering Quality of Life questionnaire (ReQoL) assessed at baseline, 3-month and 6-month follow-up. Participants will be invited to a study in which they may self-select to access an AEP service for six months. Self-reported health, demographic and psychosocial influences will be measured and incorporated in analyses as covariates. This is a pragmatic observational approach to evaluating effectiveness, in which participants who attend the AEP service will be compared with those who decline. Reasons for non-participation will be explored, and rates of recruitment and adherence will be examined. Findings will provide insight into implementing AEP services in mental health settings. Ethics and Dissemination:Ethics approval has been obtained from the Metro South Health Human Research Ethics Committee (HREC/2024/QMS/109698). We plan to submit a manuscript of the results to a peer-reviewed journal. Results will be presented at conferences, community and consumer forums and hospital grand rounds. Trial Registration:The trial is registered under the Australian and New Zealand Clinical Trial Registry (ACTRN12624001148561).

We identified significant trends in CSA disclosure characteristics. Many people first disclose in childhood, often within a year. Yet, many only disclose in adulthood, after a long delay. While disclosure is becoming more common, measures are required to facilitate disclosure and supportive responses. Findings have implications for health, education and legal systems.

Research suggests that the dimensions of childhood maltreatment (type, age of onset, duration, frequency and perpetrator) play an important role in determining health and wellbeing outcomes, though little information is available on these dimensions for any care experienced cohorts. This study aimed to determine if any variation in maltreatment dimensions were experienced between two subsets of the nationally representative Australian Child Maltreatment Study, both of which reported childhood maltreatment histories: care-experienced ( n = 358) and non-care-experienced ( n = 4922). Using a series of independent t-tests and chi-square tests, we compared the two groups on seven dimensions (number of maltreatment types, range of maltreatment items, age of onset, duration, frequency, perpetrator number, and perpetrator type) for the five child maltreatment types (physical, emotional, sexual abuse, neglect, and exposure to domestic violence). Results showed that the care-experienced group reported a higher intensity of maltreatment, being younger when maltreatment first started, experiencing greater variety of maltreatment types, for longer periods, more times and by more perpetrators than maltreated people with no care experience. We conclude that children and young people in out-of-home care experience maltreatment at a higher intensity than the rest of the population, which has implications for effective treatment.

Corporal punishment is associated with adverse outcomes; however, little empirical data exists about the state of corporal punishment in Australia. This paper presents the first national prevalence estimates of experiences of corporal punishment during childhood among Australians and its use as adults by Australian parents and caregivers. We also report community beliefs about the necessity of corporal punishment. Results show corporal punishment remains common in Australia. A high proportion of Australians (62.5%) experienced corporal punishment in childhood, including almost 6 in 10 (58.4%) young people aged 16–24. Approximately half of all parents surveyed (53.7%) had used corporal punishment. A quarter of Australians (26.4%) believe corporal punishment is necessary to raise children, 73.6% do not view it as necessaryThe use of corporal punishment and belief in its necessity are lower among younger people. Findings indicate the experience of corporal punishment remains unacceptably high in Australia but that the use of corporal punishment and beliefs about its necessity may be changing. These findings have significant implications for policy and practice in Australia. Changes in legislation could reduce this form of violence toward children. Relatively low rates of endorsement of the necessity of corporal punishment suggest the Australian community may be receptive to attempts for law reform in this area.

This study evaluated the comorbidity rates of autism spectrum disorder (ASD) with functional neurological disorders (FNDs). A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A subset of data was suitable for meta-analysis of proportions. Studies which assessed either the prevalence of ASD in patients with FNDs, or the prevalence of FNDs in patients with ASD were considered. Critical appraisal was conducted using Joanna Briggs Institute Critical Appraisal Tools. Fourteen studies met the inclusion criteria. Three cross-sectional studies which reported the comorbidity of ASD among children presenting with functional seizures met inclusion for meta-analysis. The pooled comorbidity rate of ASD in this group was 10.26% [3.92, 18.95], with an I2 value of 81%, indicating significant heterogeneity between studies. Most included studies ( n = 5) reported on the rates of Somatic Symptom Disorders in adults with ASD. Comorbidity rates were also reported for ASD with Functional Motor Disorders and for mixed FND cohorts. Critical appraisal indicated that studies were underpowered, did not match cases with controls and failed to account for confounding factors. Identifying ASD and FND comorbidity may guide treatment options and reduce the risks of unnecessary medical investigations. Lay abstract Autism spectrum disorder (ASD) and functional neurological disorders (FND) are relatively common conditions, and there has been recent interest in the overlap between them. Both conditions share core features of alexithymia, impaired interoception and deficits in attentional focus. To date, relatively little is known about the comorbidity rates between ASD and FND. This is the first meta-analysis and qualitative synthesis on the subject. We found that around 10% of children presenting with functional seizures have a comorbid ASD diagnosis. People with ASD are more likely than the neurotypical population to have functional somatic disorders, and there is also evidence that ASD rates are higher for other FNDs such as functional motor disorders. Since FND comes with risks of unnecessary medical procedures and investigations, it is important to recognize the potential for people with ASD to have an FND comorbidity.

OBJECTIVE:The authors sought to explore the role of iron supplementation in the management of neurodevelopmental disorders among children and youths. METHODS:A systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. A subset of results was suitable for meta-analysis. The quality of the evidence and strength of the clinical recommendations were assessed by using the Grading of Recommendations, Assessment, Development, and Evaluation method, and critical appraisal was conducted with the Joanna Briggs Institute critical appraisal tools. RESULTS:Nine articles met inclusion criteria. These articles included studies of attention-deficit hyperactivity disorder (ADHD) (N=7), autism spectrum disorder (N=1), and Tourette's syndrome (N=1). Three randomized controlled trials evaluating iron supplementation for ADHD hyperactivity symptom severity (124 participants: placebo, N=56; supplement, N=68) met inclusion criteria for a meta-analysis. Effect sizes for the placebo and supplement groups were moderate (Cohen's d=0.76) and large (Cohen's d=1.70), respectively, although these differences were not significant. The impact of iron supplementation on inattentive ADHD symptom severity was examined in two trials (75 participants: placebo, N=31; supplement, N=44). Large, nonsignificant effect sizes were demonstrated for the placebo (Cohen's d=1.66) and supplementation (Cohen's d=3.19) groups. The quality of the evidence and strength of the clinical recommendations were considered very low. CONCLUSIONS:Further research is needed to examine the role of iron supplementation in the management of ADHD and neurodevelopmental disorders more generally. Additionally, iron supplementation comes with risks, including death in the case of overdose.

This study aimed to explore key characteristics of the out-of-home care subgroup of a nationally representative Australian sample. To ensure that mental health services are appropriately targeted, it is critical that we understand the differential impacts of childhood experiences for this cohort. Using the Australian Child Maltreatment Study (N = 8503), we explored patterns of childhood maltreatment and adversity of participants who reported ever being placed in out-of-home care, such as foster care or kinship care. In addition, the prevalence of current and lifetime diagnosis of four mental health disorders were explored. Results showed that the care experienced subgroup reported more types of maltreatment and adverse experiences than the control group. They were also more likely to meet diagnostic threshold for post-traumatic stress disorder, generalised anxiety disorder and major depressive disorder than the control group. These findings can be used to guide mental health practitioners to target interventions more effectively within the out-of-home care cohort.

BACKGROUND:Little evidence exists about the prevalence of child sexual abuse (CSA) inflicted by different relational classes of perpetrators (e.g., parents; institutional adults; adolescents), and by individual types of perpetrators (e.g., fathers and male relatives; male teachers and male clergy; known and unknown adolescents).OBJECTIVE:To generate evidence of the prevalence of CSA by different perpetrators, and trends by victim gender and age group.PARTICIPANTS AND SETTING:The Australian Child Maltreatment Study collected information about CSA victimisation from a nationally-representative sample of 8503 individuals aged 16 and over.METHODS:We analysed data about 42 perpetrator types, collapsed into eight classes. We generated national prevalence estimates of CSA inflicted by each perpetrator class and individual perpetrator type, and compared results by victim gender and age group.RESULTS:Australian CSA prevalence was 28.5%, with the following prevalence by perpetrator classes: other known adolescents (non-romantic): 10.0%; parents/caregivers in the home: 7.8%; other known adults: 7.5%; unknown adults: 4.9%; adolescents (current/former romantic partners): 2.5%; institutional caregivers: 2.0%; siblings: 1.6%; unknown adolescents: 1.4%. Women experienced more CSA by all perpetrator classes except institutional caregivers. Age group comparison showed significant declines in CSA by parents/caregivers, and other known adults; and increases in CSA by adolescents (current/former romantic partners). Individual perpetrator type comparison showed declines in CSA by fathers, male relatives living in the home, non-resident male relatives, and other known male adults; and increases in CSA by known male adolescents, current boyfriends, and former boyfriends.CONCLUSIONS:CSA by adults has declined, indicating positive impacts of prevention efforts. However, CSA by adolescents has increased. Further declines in CSA by adults are required and possible. Targeted prevention of CSA by adolescents must be prioritised.

BACKGROUND:Little population-based evidence exists about prevalence of lifetime disclosure and non-disclosure of child sexual abuse (CSA). Evidence is lacking about disclosure by girls and women compared with boys and men, and gender diverse individuals. It is unclear if disclosure is more common in contemporary society, and if disclosure is influenced by abuse severity and perpetrator type. OBJECTIVE:We aimed to identify prevalence of lifetime disclosure of CSA, and prevalence by gender, age group, abuse severity and perpetrator. PARTICIPANTS AND SETTING:The Australian Child Maltreatment Study collected information about CSA victimisation from a nationally representative sample of 8503 individuals aged 16 and over; 28.5 % (n = 2348) experienced CSA and provided information about disclosure. METHODS:We generated national estimates of lifetime CSA disclosure, compared results by gender and age group, and identified differences by severity and perpetrator. RESULTS:Prevalence of lifetime CSA disclosure was 54.8 %, and prevalence of non-disclosure was 45.2 %. Disclosure was more common for women (60.3 %) than men (42.2 %). Disclosure was more common among those aged 16-24 (70.5 %) than those aged 25-44 (61.9 %) and 45 and over (46.2 %). Prevalence was similar across four CSA sub-types (47.2 %-58.2 %). Disclosure varied across perpetrator classes. CONCLUSIONS:Population-wide, almost one in two people who experience CSA had not disclosed. Men and those aged 45 and over were less likely to disclose. Increased disclosure by younger participants indicates progress in societal understanding of CSA. However, continued widespread non-disclosure indicates further efforts are needed to support those with lived experience of CSA to seek assistance.

BACKGROUND:Numerous national public inquiries have highlighted the problem of child sexual abuse in religious organizations. Despite this, evidence of population-wide prevalence is scarce. OBJECTIVE:To provide the first nationally representative prevalence estimates of child sexual abuse perpetrated by adults in religious organizations in Australia. METHODS:The Australian Child Maltreatment Study (ACMS) surveyed 8503 people aged 16 and over about their experiences of child maltreatment. Weighted prevalence estimates were calculated based on responses to the child sexual abuse questions from the Juvenile Victimization Questionnaire-R2: Adapted Version (ACMS). RESULTS:One in 250 people reported being sexually abused as a child by an adult in a religious organization (0.4 %, 95 % CI, 0.3-0.6 %). Men reported significantly higher rates of child sexual abuse by these perpetrators (0.8 %, 95 % CI, 0.5-1.2 %), compared to women (0.1 %, 95 % CI, 0-0.3 %). This type of sexual abuse was overwhelmingly perpetrated by men (0.4 %, 95 % CI, 0.3-0.6 %), compared to women (0 %, 95 % CI, 0-0.1 %), and was substantially more often experienced in Catholic organizations (71.9 %) than other Christian denominations or other religions. Prevalence of child sexual abuse in religious organizations has declined over time (2.2 % of men 65 years and older, compared with 0.2 % of 16-24-year-old men). CONCLUSIONS:Child sexual abuse has been widespread in religious organizations in Australia. A decline over time indicates progress has been made in preventing sexual abuse of children. Religious organizations must take all reasonable measures to prevent child sexual abuse, with a particular need for interventions targeting male leaders, and organizational cultures.