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This study tested moderators of the association between cumulative IBSA exposure (number of IBSA forms endorsed before age 18) and psychological distress, suicide attempts, and self-harm in a diverse U.S. convenience sample of 2,854 young adults who reported 4,205 incidents of IBSA during childhood or adolescence. In fully adjusted models, the main effects of cumulative IBSA exposure were not statistically significant; however, its associations with mental health outcomes varied across incident, developmental, and sociodemographic characteristics. Childhood adversity and sex assigned at birth moderated the association with psychological distress. Dating-partner involvement and repeated victimization moderated the association with suicide attempts, while adult-perpetrator involvement, explicit sexual content, racial or ethnic minority status, and educational attainment moderated the association with self-harm. Commercial involvement was associated with higher odds of suicide attempts but lower odds of self-harm. These findings underscore the importance of trauma-informed, context-sensitive responses that account for heterogeneity in survivors\u2019 experiences and vulnerabilities.<\/jats:p>","DOI":"10.1177\/10775595261471518","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:15:08Z","timestamp":1785298508000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Moderators of Mental Health Outcomes Following Childhood and Adolescent Image-Based Sexual Abuse"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8221-9425","authenticated-orcid":false,"given":"Ateret","family":"Gewirtz-Meydan","sequence":"first","affiliation":[{"name":"University of Haifa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1974-1637","authenticated-orcid":false,"given":"Kimberly J.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"University of New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Jones","sequence":"additional","affiliation":[{"name":"University of New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2900-2419","authenticated-orcid":false,"given":"Heather A.","family":"Turner","sequence":"additional","affiliation":[{"name":"University of New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7008-4252","authenticated-orcid":false,"given":"David","family":"Finkelhor","sequence":"additional","affiliation":[{"name":"University of New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"e_1_3_5_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13178-021-00536-3"},{"key":"e_1_3_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chb.2025.108576"},{"key":"e_1_3_5_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-005-0624-4"},{"key":"e_1_3_5_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/1557085116654565"},{"key":"e_1_3_5_6_1","doi-asserted-by":"publisher","DOI":"10.4159\/9780674028845"},{"key":"e_1_3_5_7_1","unstructured":"Canadian Centre for Child Protection. 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