{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T18:20:53Z","timestamp":1766686853343,"version":"3.48.0"},"reference-count":23,"publisher":"BMJ","issue":"6988","license":[{"start":{"date-parts":[[1995,5,6]],"date-time":"1995-05-06T00:00:00Z","timestamp":799718400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"accepted":{"date-parts":[[1995,3,24]]},"published-print":{"date-parts":[[1995,5,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Objective<\/jats:bold>\n                    : To evaluate a pilot service offering therapy specifically to adults with a history of child sexual abuse.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design<\/jats:bold>\n                    : Questionnaire survey.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Setting<\/jats:bold>\n                    : Specialised therapy unit, Breakfree, which offers care, therapy, and support.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Subjects<\/jats:bold>\n                    : 116 clients presenting to the service who were offered therapy.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Main outcome measures<\/jats:bold>\n                    : Scores from three psychological questionnaires\u2014the social activities and distress scale, the general health questionnaire, and the delusions, symptoms, and states inventory\u2014and from questionnaires about the clients' abuse, previous use of health services, and opinion of the Breakfree service.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results<\/jats:bold>\n                    : Clients had received previous help from health services and other agencies without apparent effect; they were highly distressed according to their psychological scores; and they were very frequent users of the health services. The clients showed significant improvement in their psychological scores (Wilcoxon's matched pairs signed ranks test): social activities and distress scale, z=-3.3, P=0.001; general health questionnaire, z=-5.8, P&lt;0.00001; delusions, symptoms, and states inventory, z=-4.8, P&lt;0.00001). This was most pronounced for those who had completed therapy by the end of the study. Whereas 82\/88 clients had a score for the general health questionnaire that indicated clinical distress at the start, only 28\/58 did so at the end of the study (only 17\/35 among those who had finished therapy).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions<\/jats:bold>\n                    : This group of adults with a history of child sexual abuse were highly disturbed and previous high users of the health service. The specialist service Breakfree was effective in the short term and, if the benefits are sustained, would yield a net cost saving to the health service.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:boxed-text position=\"float\">\n                      <jats:sec>\n                        <jats:title>Key messages<\/jats:title>\n                        <jats:list list-type=\"bullet\">\n                          <jats:list-item>\n                            <jats:p>Key messages<\/jats:p>\n                          <\/jats:list-item>\n                          <jats:list-item>\n                            <jats:p>Breakfree was set up as a pilot service to offer help to adults with such a history<\/jats:p>\n                          <\/jats:list-item>\n                          <jats:list-item>\n                            <jats:p>The clients presenting to this service reported that conventional services had failed them<\/jats:p>\n                          <\/jats:list-item>\n                          <jats:list-item>\n                            <jats:p>Adults who have been sexually abused as children are high users of the health service and are highly distressed psychologically<\/jats:p>\n                          <\/jats:list-item>\n                          <jats:list-item>\n                            <jats:p>A specialist service offers a highly effective therapy, which, if the benefits are sustained, will be cost effective<\/jats:p>\n                          <\/jats:list-item>\n                        <\/jats:list>\n                      <\/jats:sec>\n                    <\/jats:boxed-text>\n                  <\/jats:p>","DOI":"10.1136\/bmj.310.6988.1175","type":"journal-article","created":{"date-parts":[[2011,10,27]],"date-time":"2011-10-27T19:34:22Z","timestamp":1319744062000},"page":"1175-1178","source":"Crossref","is-referenced-by-count":30,"title":["Adults with a history of child sexual abuse: evaluation of a pilot therapy service"],"prefix":"10.1136","volume":"310","author":[{"given":"David","family":"Smith","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Pearce","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike","family":"Pringle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Caplan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1995,5,6]]},"reference":[{"key":"2025122510171761000_310.6988.1175.1","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1136\/bmj.300.6726.705","article-title":"Medical problems of adults who were sexually abused in childhood.","volume":"300","author":"Arnold","year":"1990","journal-title":"BMJ"},{"key":"2025122510171761000_310.6988.1175.2","doi-asserted-by":"publisher","DOI":"10.1016\/0145-2134(85)90054-7"},{"issue":"1","key":"2025122510171761000_310.6988.1175.3","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1001\/archfami.2.1.29","article-title":"Men sexually abused in childhood: Sequelae and implications for the family physician.","volume":"2","author":"Butler","year":"1993","journal-title":"Arch Fam Med"},{"key":"2025122510171761000_310.6988.1175.4","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/S0095-4543(21)00399-7","article-title":"Adult survivors of sexual abuse.","volume":"20","author":"Courtois","year":"1993","journal-title":"Prim Care"},{"key":"2025122510171761000_310.6988.1175.5","doi-asserted-by":"publisher","DOI":"10.1016\/0145-2134(94)90026-4"},{"key":"2025122510171761000_310.6988.1175.6","doi-asserted-by":"publisher","DOI":"10.1001\/archfami.1994.01850160062014"},{"key":"2025122510171761000_310.6988.1175.7","unstructured":"Hall L Lloyd S .Surviving child sexual abuse. A handbook for helping women challenge their past. 2nd ed. Falmer: London, 1993."},{"key":"2025122510171761000_310.6988.1175.8","unstructured":"Kelly L Regan L Burton S .An exploratory study of the prevalence of sexual abuse in a sample of 16\u201321 year olds. London: Child Abuse Studies Unit, Polytechnic of North London, 1991."},{"key":"2025122510171761000_310.6988.1175.9","doi-asserted-by":"crossref","first-page":"276","DOI":"10.3109\/02813439308994843","article-title":"Indicators of childhood sexual abuse in gynaecological patients in a general practice.","volume":"11","author":"Kirkergen","year":"1993","journal-title":"Scand J Prim Health Care"},{"key":"2025122510171761000_310.6988.1175.10","unstructured":"Nash CL West DJ . Sexual molestation of young girls: a retrospective study. In: West DJ ed.Sexual victimization. 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