Background Although many meta-analyses have examined the association between childhood sexual abuse and subsequent outcomes, the scope, validity, and quality of this evidence has not been comprehensively assessed. We aimed to systematically review existing meta-analyses on a wide range of long-term psychiatric, psychosocial, and physical health outcomes of childhood sexual abuse, and evaluate the quality of the literature. Methods In this umbrella review, we searched four databases (PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Global Health) from inception to Dec 31, 2018, to identify meta-analyses of observational studies that examined the association between childhood sexual abuse (before 18 years of age) and long-term consequences (after 18 years). We compared odds ratios (ORs) across different outcomes. We also examined measures of quality, including heterogeneity between studies and evidence for publication bias. This study is registered with PROSPERO, CRD42016049701. Findings We identified 19 meta-analyses that included 559 primary studies, covering 28 outcomes in 4 089 547 participants. Childhood sexual abuse was associated with 26 of 28 specific outcomes: specifically, six of eight adult psychiatric diagnoses (ORs ranged from 2•2 [95% CI 1•8-2•8] to 3•3 [2•2-4•8]), all studied negative psychosocial outcomes (ORs ranged from 1•2 [1•1-1•4] to 3•4 [2•3-4•8]), and all physical health conditions (ORs ranged from 1•4 [1•3-1•6] to 1•9 [1•4-2•8]). Strongest psychiatric associations with childhood sexual abuse were reported for conversion disorder (OR 3•3 [95% CI 2•2-4•8]), borderline personality disorder (2•9 [2•5-3•3]), anxiety (2•7 [2•5-2•8]), and depression (2•7 [2•4-3•0]). The systematic reviews for two psychiatric outcomes (post-traumatic stress disorder and schizophrenia) and one psychosocial outcome (substance misuse) met high quality standards. Quality was low for meta-analyses on borderline personality disorder and anxiety, and moderate for conversion disorder. Assuming causality, population attributable risk fractions for outcomes ranged from 1•7% (95% CI 0•7-3•3) for unprotected sexual intercourse to 14•4% (8•8-19•9) for conversion disorder. Interpretation Although childhood sexual abuse was associated with a wide range of psychosocial and health outcomes, systematic reviews on only two psychiatric disorders (post-traumatic stress disorder and schizophrenia) and one psychosocial outcome (substance misuse) were of a high quality. Whether services should prioritise interventions that mitigate developing certain psychiatric disorders following childhood abuse requires further review. Higher-quality meta-analyses for specific outcomes and more empirical studies on the developmental pathways from childhood sexual abuse to later outcomes are necessary. Funding Wellcome Trust.

As the field of psychology increasingly recognizes the importance of engaging in work that advances social justice and as social justice-focused training and practice in the field grows, psychologists need ethical guidelines for this work. The American Psychological Association's ethical principles include "justice" as a core principle but do not expand extensively upon its implications. This article provides a proposed set of ethical guidelines for social justice work in psychology. Within the framework of 3 domains of justice-interactional (about relational dynamics), distributive (about provision for all), and procedural (about just processes) justice-this article outlines 7 guidelines for social justice ethics: (1) reflecting critically on relational power dynamics; (2) mitigating relational power dynamics; (3) focusing on empowerment and strengths-based approaches; (4) focusing energy and resources on the priorities of marginalized communities; (5) contributing time, funding, and effort to preventive work; (6) engaging with social systems; and ( 7) raising awareness about system impacts on individual and community well-being. Vignettes of relevant ethical dilemmas are presented and implications for practice are discussed. Public Significance StatementThis article explores the need for a set of ethical standards to guide psychologists' social justiceoriented work. It conceptualizes social justice as having three components, focused on relational dynamics, provision for all, and just processes. Additionally, it outlines and provides examples of seven proposed standards for social justice ethics in psychology.

No abstract

The development of psychological and behavioral therapies over the past several decades has led to what is termed the third wave of psychotherapy, a collection of treatments that adopt a new approach to maladaptive cognitions and target broad, contextualistic goals. Within the field of behavioral sleep medicine, treatments for insomnia have followed a similar evolution, and several emerging therapies, including mindfulness and acceptance-based therapies, have begun to accumulate evidence as effective treatments for this sleep disorder over the past several decades. This paper discusses the historical background of the third wave of psychotherapy, introduces each of the third-wave therapies that have been applied to the treatment of insomnia, and reviews the recent literature to critique the effectiveness of these treatments. Relevant controversies with the third-wave therapies are discussed to inform future directions in insomnia research.

Heightened attention to police brutality has created momentum for alternative, community-based responses to violence, including that inflicted by an intimate partner. But to build effective alternatives, we must know what survivors already do in moments of acute danger when they do not call the police. This study sought to explore these moments from an ecological perspective. Using a qualitative descriptive methodology, we conducted 25 interviews with a diverse sample of intimate partner violence (IPV) survivors. Each described the first, the worst, and the most recent IPV incident, whom they reached out to and why, the outcomes of their help-seeking, and the individual, interpersonal, and psychosocial influences on the process. Even in the face of severe violence, what participants most wanted was someone who would listen without judgment. Direct interpersonal factors that influenced their help-seeking included their partner’s controlling behavior, as well as their network members’ capacities, perspectives on IPV, and feelings about the survivor. Broader influential factors included the radiating effects of IPV and other forms of trauma in survivors’ networks. Participants offered recommendations on how domestic violence (DV) programs could both strengthen survivors’ networks and provide them with targeted community support in moments of grave danger. As we continue to develop community-based alternatives to police intervention, DV programs have a critical opportunity to build on survivors’ own recommendations. This process must address the ongoing effects of trauma that hamper the ability of so many network members to support survivors in crisis.