Stress, appraisal, and coping in child sexual abuse: a theoretical and empirical review.

A review of theories to predict the mental health effects of child sexual abuse suggests that existing models have not adequately defined stress and coping constructs and have not specified how those variables might interact with other environmental factors. This article outlines a transactional model that conceptualizes sexual abuse as a stressor consisting of a series of abuse events, abuse-related events, and disclosure-related events that each tend to increase risk for maladaptive outcomes. The model also proposes that cognitive appraisals and coping responses mediate the effects of these events, that developmental and environmental factors may moderate relationships between sexual abuse stressors and victim responses, and that victims' initial responses may effect subsequent levels of abuse-related stress. Empirical studies relevant to the major components of this model are reviewed, and the implications of these findings for future research are considered.