Essai doctoral présenté à la Faculté des arts et des sciences en vue de l’obtention du grade de Docteur en psychologie, option psychologie clinique (D.Psy.)

O estudo faz parte de pesquisa multicêntrica \"Estudo Internacional de Violência no Namoro - IDVS\", usando seu instrumento padronizado. Objetivou-se contribuir para o reconhecimento da ocorrência de violência entre parceiros íntimos na fase de namoro, tendo como base conceitual as questões de gênero e seus elementos para a compreensão da constituição da relação de intimidade. Dialoga, ainda, com as teorias do desenvolvimento humano, da aceitação da violência na resolução de conflitos e do aprendizado da violência da perspectiva geracional. Os recortes propostos foram três: um estudo descritivo sobre as prevalências da violência, ao longo do relacionamento de namoro e em seus diversos tipos; um segundo, abordou a violência e os fatores associados, e um terceiro, avaliou o impacto da violência na saúde mental a partir do quadro de depressão. O questionário foi auto preenchido por 362 alunos de duas universidades, uma pública e outra privada, do Estado de São Paulo, sendo 37% do sexo masculino e 63% do feminino, com idade mediana de 20 anos. Estimou-se a prevalência da violência em relacionamentos íntimos, sofrida ou perpetrada, para os tipos físico, psicológico e sexual, descrevendo-se as sobreposições entre eles. Quanto às violências, 75,9% sofreu algum tipo na vida e 76,4% as perpetraram. O tipo de violência mais prevalente, tanto sofrida como perpetrada, foi a psicológica, seguida da sexual. A grande sobreposição entre violências sofridas e perpetradas (83,9%) reflete a reciprocidade das agressões, sem diferença entre homens e mulheres. Na análise dos fatores associados ter vida sexual no namoro e aprovação da violência se mantiveram associadas a sofrer violência para as mulheres, enquanto para os homens ter tempo de namoro maior de 6 meses e uso associado de álcool e drogas mantiveram-se associados. No caso da violência perpetrada, mantiveram-se associadas para as mulheres o uso de substância 01psicoativa do tipo associação droga e álcool, ciúmes e tempo de namoro maior de dois anos. No modelo que considerou os tipos de violência e a associação com depressão, para as mulheres ter sofrido violência física exclusiva e física e sexual concomitantes mantiveram-se associadas. Os resultados estão em consonância com a literatura que analisa a violência no namoro, com alta prevalência de violências sofridas e perpetradas, além da reciprocidade tanto entre homens como entre mulheres. A situação de conjugalidade parece alterar quer a mutualidade das agressões, quer o sentido das violências e os agressores, para mulheres e para homens, em contraste com a situação de namoro. As consequências da vitimização no namoro para as mulheres são mais expressivas, enquanto que para os homens é importante se examinar com maior detalhamento as especificidades para a questão do ponto de vista masculino. Os achados trazem para o contexto brasileiro a confirmação da necessidade de ações e políticas públicas nesta direção, ao produzir conhecimento importante para programas de prevenção para jovens em fase de namoro, seja no plano dos serviços de saúde, seja no das escolas e universidades, onde se concentram os jovens, de forma a minimizar as chances de que as agressões continuem no casamento. / The study is part of a multicenter survey \"International Study of Violence in Dating - IDVS\" using its standardized instrument. The objective was to contribute for the recognition of the occurrence of intimate partner violence during phase dating, based on conceptual issues of gender and its elements for understanding the formation of intimate relationship. Dialogue also with theories of human development, the acceptance of violence in conflict resolution and learning the violence of generational perspective.The proposed cut were three: a descriptive study on the prevalence of violence over the dating relationship and its various types; a second, addressed the violence and associated factors; and a third, evaluated the impact of violence on mental health from the depression disorder. The questionnaire was self-reported by 362 undergraduate students from two universities, one public and one private, of the State of São Paulo, with 37% male and 63% female, median age 20 years. We estimated the prevalence among students of violence in intimate relationships, suffered or perpetrated, for the kinds physical, psychological and sexual, describing the overlap among them. As for violence, 75.9% suffered some sort in life and 76.4% were perpetrators. The most prevalent type of violence, both suffered as perpetrated, was psychological, followed by sexual. The large overlap between violence suffered and perpetrated (83.9%) reflects the reciprocity of aggression, with no difference between men and women. In the analysis of factors associated with sex life in dating and approval of violence remained associated to suffer violence for women, while for men longer relationship more than 6 months and use of alcohol and drugs concomitant remained associated. In the case of perpetrated violence, the use of drugs and alcohol concomitant, jealousy and long relationship more than two years remained associated for women. In the model considered the types of violence and the association with depression, for women have suffered physical violence exclusive and physical and sexual concurrent remained associated. The results are consistent with previous literature on dating violence that shows high prevalence of violence suffered and perpetrated, beyond reciprocity between both, men and women. The situation seems to change either marital mutuality of aggression, whether the meaning of violence and the perpetrators, for women and for men, in contrast to the dating situation. The consequences of victimization in dating for women are more expressive, while for men it is important to examine in greater detail the specifics for the issue of male point of view. The findings of this study bring to the Brazilian context confirming the need for action and public policy in this direction, to produce important knowledge for prevention programs for young people in the stage dating, either in the health service, either in schools and universities, which concentrates the specific population of young people, in order to minimize the chances that the assaults continue in the marriage.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-06-21T12:06:44Z No. of bitstreams: 1 lilianaguiarvieira.pdf: 829755 bytes, checksum: bafd8acee6f1b0f73d3e0f36cd430974 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-13T15:27:20Z (GMT) No. of bitstreams: 1 lilianaguiarvieira.pdf: 829755 bytes, checksum: bafd8acee6f1b0f73d3e0f36cd430974 (MD5) / Made available in DSpace on 2016-07-13T15:27:20Z (GMT). No. of bitstreams: 1 lilianaguiarvieira.pdf: 829755 bytes, checksum: bafd8acee6f1b0f73d3e0f36cd430974 (MD5) Previous issue date: 2012-03-28 / A relação existente entre capital social e a saúde tem sido objeto de estudo há longa data. A participação cívica encontra-se presente em legislações de saúde, nos movimentos pela prevenção e promoção da saúde e nas conferências e conselhos de saúde. Este estudo busca contribuir com a discussão da existência de associação entre saúde e capital social. Foram verificadas associações entre taxa de mortalidade por causas externas – agressão e lesões autoprovocada – e participação ativa na vida associativa dos indivíduos, manifestações de interesse na organização da sociedade civil e atividade dos conselhos gestores municipais, em municípios com mais de 100.000 habitantes. Aplicou-se o método de regressão múltipla assimétrica no modelo skew-normal. Utilizaram-se como variáveis de controle: Coeficiente de GINI, renda per capita dos municípios, IFDM e o PIB. Os resultados mostram existência de associação entre as taxas de mortalidade e variáveis que captam aspectos do capital social. Mortalidade por agressão e mortalidade por lesões autoprovocadas apresentaram perfis diferentes de associação com variáveis relacionadas ao capital social. / The relationship between social capital and health has been studied for a long time. Civic participation is present in the laws of health, health promotion movements and other councils and conferences about health. This study intends to contribute to the discussion of the existence of an association between health and social capital. Associations were found between mortality from external causes - aggression and self-harm injuries - and active participation in associational life of citizens, expressions of interest in civil society organization and activity of the municipal councils in cities with more than 100,000 habitants. Method was applied in multiple regression assymmetric skew-normal model. Thus, some control variables were used: Gini coefficient, per capita income of the cities, municipal development Firjan index (IFDM) and the Gross National Product (PIB). The results show an association between mortality rates and variables that capture aspects of social capital. Mortality from aggression and self-harm mortality showed different patterns of association with variables related to social capital.

Le phénomène d’agression sexuelle sur les enfants et la sévérité des conséquences qu’il engendre représentent un problème social important. Les recherches effectuées sur le sujet indiquent que les répercussions négatives associées à l’agression concernent la majorité des victimes. Les séquelles sur le plan psychologique et comportemental ont été bien documentées à ce jour, alors que les connaissances sont plus rares en ce qui concerne l’impact de l’agression sexuelle sur la santé sexuelle, notamment auprès des adolescentes. L’objectif de ce mémoire est d’explorer les conséquences d’une agression sexuelle commise pendant l’enfance sur le plan de la santé sexuelle des adolescentes, ainsi que les facteurs de protection susceptibles de contribuer au rétablissement des victimes. L’échantillon est composé de 125 adolescentes victimes d’agression sexuelle, ayant rempli un questionnaire pour mesurer les caractéristiques de l’agression vécue et différents indicateurs liés à la santé sexuelle. Les résultats révèlent que les adolescentes actives sexuellement présentent différents comportements sexuels à risque pouvant affecter leur santé sexuelle notamment l’âge du premier rapport sexuel consentant, le nombre de partenaires sexuels, l’utilisation du condom, la grossesse à l’adolescence et les comportements sexuels en échange de biens. D’autre part, parmi les facteurs de protection considérés, seul le soutien maternel s’est révélé avoir une incidence positive sur le risque de s’engager dans des activités liées à la prostitution. Les autres facteurs de protection n’ont révélé aucun lien significatif contrairement aux hypothèses. Enfin, les données issues de la présente recherche soulignent le fait que les victimes d’ASE plus sévère sont davantage susceptibles de s’engager dans des rapports sexuels non protégés. Par ailleurs, l’ASE commise dans l’environnement intrafamilial prédit un plus grand nombre de partenaires sexuels chez les adolescentes interrogées. Ainsi, les interventions cliniques intégrant la mère dans la thérapie et optimisant les connaissances sur les moyens de contraception et leur nécessité dans la prévention des infections transmises sexuellement et des grossesses non désirées pourraient être particulièrement pertinentes auprès des adolescentes survivantes d’agression sexuelle. / The phenomenon of sexual abuse on children and the severity of its consequences is an important social problem. Research on the subject indicates that the negative impact of assaults affects the vast majority of victims. The psychological and behavioral repercussions have been well documented to this day, yet the result involving the impact of the abuse on sexual health, especially amongst adolescents, have been scantly investigated. The aim of this research is to explore the consequences of child sexual abuse (CSA) on adolescent sexual health, as well as the protective factors that may contribute to the recovery of victims. The sample consisted of 125 female adolescents that have been sexually abused, who have completed a questionnaire measuring the characteristics of their assault and different indicators related to sexual health. Results show that sexually active adolescent present different unhealthy sexual behaviors that may affect their sexual health, including early age of first sexual relations, number of sexual partners, condom use, pregnancy and prostitution. Among the different protective factors considered, only maternal support was found to have a positive impact on the risk of engaging in prostitution-related activities. The other protective factors revealed no significant link contradicting the hypothesis. Finally, data from this research highlights the fact that more severe CSA victims are more likely to engage in unprotected sex. Moreover, the CSA committed by an intra-familial perpetrator predicted a greater number of sexual partners. Thus, clinical interventions that integrate the mother into therapy and maximize knowledge about contraception and their necessity in preventing sexually transmitted infections and unwanted pregnancies may be particularly relevant to CSA teenage survivors.

No description available.

Les enfants victimes d'agression sexuelle (VAS) peuvent vivre des difficultés variées à la suite de leur victimisation. Parmi ces difficultés, des conséquences notamment sur le plan psychologique peuvent être vécues, telles que de l'anxiété et des symptômes dépressifs. À la suite du dévoilement de l'agression sexuelle (AS), la trajectoire de services de l’enfant peut varier selon le degré d’intervention de la Direction de la protection de la jeunesse (DPJ), engendrant des changements marqués dans sa vie. Le modèle théorique de Friedrich (1990) stipule que ces changements pouvant impliquer une rupture de liens au sein de la famille (ex : par un placement de l'enfant ou un interdit de contact avec le présumé agresseur), pourraient exercer une influence sur la culpabilité ressentie par l'enfant, lequel pourrait également se culpabiliser par rapport aux causes de l'AS. Une autre théorie stipule que la réaction émotionnelle de l’enfant à la suite du dévoilement peut varier en fonction d’un certain nombre de facteurs personnels, familiaux et contextuels (Spaccarelli, 1994). Bien que l’influence de certains facteurs contextuels et familiaux ait été explorée par le passé (telle que l'importance du soutien à la suite du dévoilement de l'AS sur le bien-être psychologique de l'enfant VAS (Lemieux et al., 2019; Quas et Goodman, 2012; Back et al., 2011)), on en sait peu sur l’influence des décisions qui sont prises dans le cadre de la prise en charge (placement par le centre jeunesse (CJE) ou l'implication continue du CJE, par exemple). Objectif : L'objectif de ce mémoire est de documenter les symptômes psychologiques des enfants VAS en lien avec leur trajectoire de prise en charge. Ainsi, le présent mémoire explore l’influence de facteurs contextuels liés à la prise en charge (placement de l'enfant, interdit de contact avec l'agresseur, l'intensité de l'implication des professionnels dans la vie de l'enfant, le contact continu avec l'intervenant du CJE en cours d'évaluation et le nombre d'évènements stressants liés au dévoilement) et de facteurs personnels (stratégies d’évitement et culpabilité) sur l’état émotionnel de l’enfant (détresse psychologique). Méthode : Ce mémoire vise à répondre à deux questions principales : 1) Quels sont les facteurs qui exercent une influence sur la détresse psychologique des enfants VAS ? Une sous-question émerge de cette question principale : les filles et les garçons expérimentent-ils le même niveau de détresse psychologique et les mêmes facteurs internes ? 2) Les facteurs externes à l'enfant exercent-ils une influence additionnelle aux facteurs internes à l’enfant sur la détresse psychologique ? Des enfants VAS ont été recrutés par le Centre d'expertise Marie-Vincent (CEMV) (n = 369), soit 249 filles et 120 garçons. Ces enfants et un de leurs parents non-agresseur ont rempli des questionnaires visant entre autres à évaluer les répercussions liées à l'AS. Afin de répondre aux questions de recherches, des analyses de régression linéaire hiérarchique et un test t pour groupes indépendants ont été exécutés. Résultats : L'intensité de l'implication des professionnels dans la vie de l'enfant, la culpabilité et les stratégies d'évitement sont associés à plus de détresse psychologique chez les enfants VAS. Le modèle final de régression hiérarchique permet de prédire près de 41% de la variance sur le score de détresse psychologique des enfants VAS. Conclusion : Les résultats obtenus concordent en partie avec la littérature actuelle. D'autres recherches seraient nécessaires notamment afin de déterminer si d'autres variables liées à la prise en charge, telles que les contacts supervisés avec l'agresseur, peuvent être associées de manière significative à la détresse psychologique ressentie par les enfants VAS. / Child victims of sexual abuse can experience a variety of difficulties as a result of their victimization. Among these difficulties, psychological consequences can be experienced, such as anxiety and depressive symptoms. Following the disclosure of the sexual abuse, the child's services trajectory may vary depending on the degree of intervention by the youth welfare services, resulting in significant changes in the child’s life. Friedrich's (1990) theoretical model stipulates that these changes, which can involve a breakdown of family ties (e.g.: resulting from the placement of the child or prohibition of contact with the presumed perpetrator), could affect the child’s feeling of guilt and may also be related to the child’s feeling of guilt about the causes of the sexual abuse. Another theory stipulates that the child’s emotional response following disclosure may be influenced by a number of personal, familial and contextual factors (Spaccarelli, 1994). Although the influence of some contextual and familial factors has been explored in the past (such as the importance of support on the child's psychological well-being following the disclosure of the abuse (Lemieux et al., 2019; Quas et Goodman, 2012; Back et al., 2011)), little is known about the influence of the decisions that are taken by the youth welfare services (placement of the child or the ongoing involvement of youth welfare services, for example). Objective: The objective of this research is to document the psychological symptoms of child victims of sexual abuse in relation to their services trajectory. This project explores the influence of contextual factors (placement of the child, prohibition of contact with the abuser, intensity of involvement of professionals in the child's life, continued involvement of youth welfare services and the number of stressful events related to disclosure) and personal factors (avoidance strategies and guilt) on the child’s emotional state (psychological distress). Method: There are two main questions leading this project: 1) Which factors can influence the psychological distress of child victims of sexual abuse? A sub-question emerges from this first main question: do boys and girls experience the same level of psychological distress and the same internal factors? 2) Do external factors to the child bring an additional influence to the child's internal factors on psychological distress? Child victims of sexual abuse were recruited by the Centre d'expertise Marie-Vincent (CEMV) (n = 369), comprising 249 girls and 120 boys. These children and one of their non-offending parents completed questionnaires to assess the impact of the sexual abuse. In order to answer the research questions, hierarchical regression analyses and test t for independents groups were performed. Results: The intensity of professional involvement in the child’s life, guilt and avoidance strategies were associated with more psychological distress experienced by child victims of sexual abuse. The final hierarchical regression model predicts nearly 41% of the variance on the psychological distress score. Conclusion: The results obtained are in part consistent with current literature. Further research would be needed, particularly to determine whether other components of the child's taking charge trajectory, such as supervised contact with the abuser, can be significantly associated with the psychological distress experienced by those children.

Police officers who maintain negative or traumatic information in long-term memory are vulnerable to mental illness, unstable emotional and behavioral responses, interpersonal problems, and impaired social relationships. The cognitive theory suggests that police officers externalize various negative or maladaptive behaviors as a result of frequent exposure to traumatic events. Researchers have found that police officers tend to either not seek mental health treatment, try to fix their own mental health problem, or if in treatment will not be forthcoming with internalized thoughts of psychological distress. The intention of this research was to examine the relationship between police officers' frequent exposure to violence and traumatic events/images and its effect on the long-term mental health issues and significant decreases in cognitive empathy or human compassion within police officers. This quantitative study used a simple linear regression, descriptive analysis, correlational matrix to analyze the data gathered from assessment packets containing a Trauma Symptom Inventory-2A, Paulhus Deception Scale, JHU Project Shields Questionnaire, and a Compassion Scale. Assessment packets were distributed during roll calls to active male and female Norfolk Police Officers assigned to the Patrol Divisions, Detective Division, and Vice/Narcotic Division. A priori power analysis revealed 65 participants were needed to have a valid sample. There were 66 completed assessment packets collected from the researcher's secure drop boxes. The findings were statistically significant suggesting a need for continued research. To effect positive social change, mental health workers and police organizations will use this data to assist in policy construction and mental health training.

Durant la dernière décennie, plusieurs études ont identifié l’agression sexuelle à l’enfance en tant que facteur de risque des troubles psychotiques. Toutefois, la survenue des troubles psychotiques chez les enfants et les adolescents ayant vécu une agression sexuelle à l’enfance a été très peu étudiée à ce jour de façon longitudinale, les études précédentes ayant majoritairement utilisé des devis rétrospectifs, étudiant les traumas à l’enfance chez les adultes ayant un trouble psychotique. Notre compréhension du développement des troubles psychotiques chez cette population est ainsi très limitée. L’objectif général de cette thèse est de mieux comprendre la survenue des troubles psychotiques chez les enfants ayant reçu un signalement d’agression sexuelle corroboré par le DPJ. Le premier article vise à documenter la prévalence des troubles psychotiques chez des jeunes agressés sexuellement entre le premier signalement corroboré d’agression sexuelle et le début de l’âge adulte. Les données administratives médicales de 882 jeunes ayant reçu un signalement d’agression sexuelle corroboré par le DPJ ont été comparées à 882 jeunes de la population générale sur une période de 13 ans. Les résultats obtenus via des modèles linéaires généralisés mixtes démontrent que les jeunes agressés sexuellement sont 10 fois plus à risque de recevoir un diagnostic de trouble psychotique que ceux de la population générale. Le second article documente la trajectoire développementale des troubles psychotiques suite à l’agression sexuelle en termes d’âge de survenue. La même méthodologie que celle du premier article est utilisée. Les analyses de survie réalisées démontrent que l’agression sexuelle et l’abus de substance sont associés à l’âge de survenue des troubles psychotiques. Ainsi, les jeunes de l’étude sont plus à risque de recevoir leur premier diagnostic de trouble psychotique plus tôt 6 dans leur développement lorsqu’ils ont reçu un signalement d’agression sexuelle et lorsqu’ils ont un diagnostic d’abus de substance. Lorsque les groupes sont comparés séparément, l’abus de substance est associé à l’âge de survenue uniquement dans le groupe agressé sexuellement. Le troisième article, de nature exploratoire, vise à identifier les facteurs psychologiques impliqués dans la survenue des troubles psychotiques chez les jeunes agressés sexuellement. Un premier objectif est d’identifier les facteurs psychologiques survenant de façon concomitante aux troubles psychotiques ; un second objectif est d’identifier les facteurs qui contribuent à prédire les troubles psychotiques. Pour cet article, seulement l’échantillon de jeunes agressés sexuellement est inclus. Les régressions logistiques révèlent que les troubles de personnalité sont significativement associés aux troubles psychotiques, les jeunes ayant reçu un tel diagnostic étant 10 fois plus à risque de recevoir également un diagnostic de trouble psychotique, peu importe l’ordre d’apparition des diagnostics. La déficience intellectuelle et l’abus de substance ont été identifiés comme contribuant à la survenue des troubles psychotiques. Les contributions théoriques de cette thèse à la littérature portant sur l’association entre l’agression sexuelle à l’enfance et la psychose ainsi que les implications cliniques pour l’intervention et la prévention auprès de cette population spécifique sont discutées. / In the last decade, several studies identified child sexual abuse as a risk factor for psychotic disorders. However, few longitudinal studies addressed the development of psychotic disorders in sexually abused children and adolescent. Previous studies mostly relied on retrospective designs, studying childhood trauma in adults with psychotic disorders, which limits our comprehension of the development of psychotic disorders in sexually abused children. The present thesis aims to achieve a better understanding of the development of psychotic disorders in youths who received a corroborated report of sexual abuse by the DYP. The first article aims to document the prevalence of psychotic disorders in sexually abused youth between the time of the first corroborated report of sexual abuse and the beginning of adulthood. Administrative databases of 882 youths who received a corroborated report of sexual abuse by the DPY were compared to 882 youths from the general population over a 13-year period. Conditional generalized linear mixed models reveal that sexually abused youth were 10 times more at risk to receive a diagnosis for a psychotic disorder than the general population. The second article documents the developmental trajectory of psychotic disorders following sexual abuse in terms of age at onset. The methods used are the same as the first article. Survival analysis reveal that sexual abuse and substance misuse are associated to the age at onset of psychotic disorder. Thus, studied youth are more at risk of receiving their first diagnosis of psychotic disorder early in their development when they received a corroborated report of sexual abuse or when they received a diagnosis for substance misuse. When the groups are compared separately, substance misuse is associated to the age at onset of psychotic disorder only in sexually abused youth. 8 The third article has an exploratory nature and aims to identify the psychological factors implied in the development of psychotic disorders in sexually abused youth. A first objective is to identify which psychological factors cooccur with psychotic disorder; a second objective is to identify which factors predicts psychotic disorders. For this article, only the sample of sexually abuse youth is used. Logistic regressions reveal that personality disorders are significantly associated to psychotic disorders. Youths with a diagnosis of personality disorders are 10 times more at risk of receiving also a diagnosis of psychotic disorder, regardless of the order in which they received either diagnosis. Intellectual disability and substance misuse are identified as factors who predict the development of psychotic disorders. The theoretical contributions of the present thesis to the literature on the association between childhood sexual abuse and psychotic disorders as well as the clinical implications for intervention and prevention programs offered to this population are discussed.

Les objectifs généraux de cette thèse visaient d'une part à déterminer si les enfants et adolescents abusés sexuellement consultaient et étaient davantage hospitalisés pour des problèmes de santé génito-urinaire que la population pédiatrique générale et d'autre part, à explorer ce qui pouvait expliquer cette différence le cas échéant. La thèse visait également à pallier les lacunes des études antérieures pour la plupart rétrospectives, transversales et conduites principalement auprès de filles, grâce à une méthodologie prospective et de cas-contrôle apparié en ayant recours aux diagnostics médicaux documentés dans les banques administratives publiques du Québec (RAMQ, MSSS) entre les années 1996 et 2013. Dans le premier article, à partir d'un échantillon de 882 enfants (1-18 ans) dont l'agression sexuelle a été corroborée et 882 enfants de la population générale appariés selon l'âge, le sexe et la région sociosanitaire, les résultats du modèle linéaire généralisé indiquent que les filles victimes d'agression sexuelle recevaient plus de diagnostics pour des problèmes de santé urinaire (RR: 2,1) et génitale (RR: 1,4), mais qu'aucune différence n'a été décelée pour les infections transmises sexuellement (ITS). Chez les garçons, ceux ayant été victimes d'agression sexuelle recevaient un nombre équivalent de diagnostics pour les problèmes de santé génitale et urinaire et les données étaient insuffisantes pour conduire des analyses et comparer les taux d'ITS. Selon le type de problèmes de santé analysé (santé génitale, urinaire ou ITS), les filles victimes d'agression sexuelle et celles de la population générale consultaient entre 2,5 et 11 fois en lien avec des diagnostics de troubles génito-urinaires comparativement aux garçons victimes ou ceux de la population générale. Les résultats de cette étude démontrent que l'agression sexuelle à l'enfance est associée à davantage de problèmes de santé urinaire et génitale chez les filles, mais pas chez les garçons. Des efforts de prévention et d'intervention précoce pour une bonne santé génito-urinaire chez les filles victimes d'agression sexuelle pourraient prévenir l'aggravation et la chronicisation de ces problèmes de santé à l'âge adulte. Le deuxième article quant à lui testait un modèle théorique biopsychologique selon lequel une plus grande détresse psychologique (mesurée par la comorbidité des troubles psychiatriques) expliquerait en partie l'effet de l'agression sexuelle sur le nombre accru de diagnostics génito-urinaires chez les filles. Les résultats issus des analyses de médiation conduites auprès de 661 filles victimes d'agression sexuelle et 661 filles de la population générale indiquent qu'après avoir contrôlé le statut socio-économique, le nombre d'années de données médicales et le nombre de diagnostics génito-urinaires/psychiatriques reçus avant la date de signalement de l'agression sexuelle, une plus grande comorbidité psychiatrique expliquait 23% de la relation entre l'agression sexuelle à l'enfance et le nombre de diagnostics urinaires et 62% de la relation entre l'agression sexuelle à l'enfance et le nombre de diagnostics génitaux. Ces résultats indiquent que plus les filles consultent après le signalement de l’agression sexuelle pour un grand nombre de troubles psychiatriques distincts (comorbidité) et plus leur risque de consulter ultérieurement pour des problèmes génito-urinaires est augmenté. Ainsi, cette conclusion suggère que l'émergence de problèmes de santé génito-urinaire des années après l'agression sexuelle pourrait être prévenue chez les filles en prenant soin directement de leur détresse psychologique. / The general objectives of this thesis were first, to determine whether children and adolescents who were sexually abused consulted or were hospitalized more often for genitourinary health problems than the general pediatric population and second, to explore what could explain this difference if any. This thesis also aimed to overcome limitations of previous studies who were retrospective, cross-sectionnal and conducted among girls for the majority, via a prospective matched-cohort design and medical diagnoses documented in Quebec's public administrative banks (RAMQ, MSSS) between 1996 and 2013. In the first article, using a sample of 882 children (1-18 years) with a substantiated report of sexual abuse and 882 children from the general population matched by age, sex and geographic area, the results of the generalized linear mixed model indicated that abused girls received more diagnoses for urinary (RR: 2.1) and genital (RR: 1.4) health problems, but no difference was found for sexually transmitted infections (STIs). Among the boys, those who have been sexually abused received an equivalent number of diagnoses for genital or urinary health problems and there were insufficient data to conduct analyses and compare STIs rates. Depending on the genitourinary health problem, sexually abused girls and those from the general population received between 2.5 and 11 times more diagnoses than abused boys or those from the general population. The results of this study indicate that childhood sexual abuse is associated with more urinary and genital health problems in girls, but not in boys. Prevention and early intervention efforts for a good genitourinary health among girls victim of sexual abuse could prevent the aggravation and chronicisation of these health problems in adulthood. The second article tested a theoretical psychobiological model according to which greater psychological distress (as measured by psychiatric comorbidity) would partly explain the effect of sexual abuse on the increased number of genitourinary diagnoses among girls. Results form mediation analyses conducted with 661 sexually abused girls and 661 girls from the general population indicated that after controlling for socio-economic level, number of years of medical data and genitourinary/psychiatric diagnostics prior sexual abuse report date, greater psychiatric comorbidity explained 23% of the relationship between child sexual abuse and the number of urinary diagnoses and 62% of the relationship between child sexual abuse and the number of genital diagnoses. These results indicate that the more girls consult after the report of sexual abuse for a large number of distinct psychiatric conditions (comorbidity), the greater their risk to consult later for genitourinary health problems. Thus, this conclusion suggests that the emergence of genitourinary health problems years after the sexual abuse could be prevented among girls by taking direct care of their psychological distress.

Peu de recherches se sont intéressées aux questions du dévoilement d'une agression sexuelle. Employant quelques concepts de la théorie de la sociologie pragmatique, cette thèse de maîtrise fait l'étude des expériences personnelles des étudiant(e)s à l'égard du dévoilement d'une agression sexuelle. Il s'agit d'une recherche qualitative reposant sur les témoignages de onze étudiant(e)s de l'Université d'Ottawa qui ont vécu une agression sexuelle durant leurs études postsecondaires, et qui ont été amené(e)s à dévoiler leur expérience à une personne ou à un service d'aide. En analysant les résultats de recherche, il en ressort que les participant(e)s ont progressé dans leur appréhension de l'agression, tout comme dans leurs logiques de dévoilement, ainsi que dans les types de dévoilement (spontané, justifié par des motifs personnels, et justifié par des motifs altruistes) - trois notions qui sont introduites. Les résultats mettent également en lumière un aspect peu connu : les réactions qui peuvent ou non faciliter un dévoilement. Cette recherche permet d'apporter un nouveau savoir sur la dynamique des décisions qui mènent un/une étudiant(e) à dévoiler sa situation d'agression sexuelle, tout en ouvrant un large espace de nouveaux questionnements. (Abstract) There is little research focused on the disclosure of a sexual assault. Employing some concepts from the pragmatic sociology theory, this master's thesis examines the personal experiences of students with respect to the disclosure of a sexual assault. This qualitative research is based on the testimonies of eleven students from the University of Ottawa who have experienced a sexual assault during their post-secondary education, and who have been led to disclose their situation to a person or a help service. In analyzing the results of this study, it emerges that the participants have progressed in their apprehension of the assault, as well as in their logics and types of disclosure (spontaneous, justified by personal motives, and justified by altruistic motives) - three notions that are introduced. The findings also shed light on a little-known aspect: the reactions that may or may not facilitate a disclosure. This research provides new knowledge on the dynamics of the decisions that leads a student to reveal his or her situation of sexual assault, while opening up a vast space for further questions.