Forms and Contexts of Child Sexual Abuse in Taiwan: Associations With Adverse Childhood Experiences, Mental Health Outcomes, and Revictimization.

Child sexual abuse (CSA) in non-Western contexts remains understudied, particularly with respect to how different forms and perpetrator-victim relationships are connected to other adverse childhood experiences (ACEs) and how they shape mental health and revictimization risk over time. This study examines the prevalence of CSA among Taiwanese children and its associations with other ACEs, psychiatric symptoms, and subsequent revictimization, with attention to both the form of sexual abuse and the perpetrator-victim relationship. Data were drawn from a nationally representative, longitudinal survey of children in the 4th and 8th grades (n = 2,599). CSA was assessed across contact (unwanted sexual touching or being forced to touch another person's private parts) and non-contact forms (forced exposure to sexual images or videos), as well as by perpetrator relationship (parent/caregiver, sibling, or peer). Results indicated that 9.81% of 4th-grade children reported experiencing at least one form of CSA in the past 12 months. Distinct ACEs were differentially associated with specific CSA forms and perpetrator relationships, revealing patterned pathways of interpersonal risk. Parental physical violence was associated with a higher likelihood of parent/caregiver-facilitated CSA, whereas parental psychological neglect and bullying victimization were linked to increased risk of peer-facilitated CSA. All forms of CSA were associated with elevated concurrent psychiatric symptoms. Longitudinal analyses further demonstrated that sibling- and peer-facilitated contact CSA predicted greater psychiatric symptoms 4 years later. Additionally, parent/caregiver- and sibling-facilitated non-contact CSA, as well as peer-facilitated contact CSA, were associated with increased risk of revictimization at follow-up. These findings highlight the importance of distinguishing CSA by both form and perpetrator relationship to better understand the interpersonal contexts in which sexual abuse occurs and its lasting consequences. Implications for targeted prevention, early identification, and intervention strategies are discussed.