Preventing sexual abusers of children from reoffending: systematic review of medical and psychological interventionsBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4630 (Published 09 August 2013) Cite this as: BMJ 2013;347:f4630
- Niklas Långström, professor12,
- Pia Enebrink, clinical psychologist, researcher3,
- Eva-Marie Laurén, senior forensic psychiatrist4,
- Jonas Lindblom, researcher56,
- Sophie Werkö, researcher56,
- R Karl Hanson, senior research scientist7
- 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77 Stockholm, Sweden
- 2Swedish Prison and Probation Administration, Norrköping, Sweden
- 3Department of Clinical Neurosciences, Division of Psychology, Karolinska Institutet, Box 281, SE-171 77 Stockholm, Sweden
- 4Stockholm County Council, Stockholm, Sweden
- 5Swedish Council on Health Technology Assessment (SBU), Stockholm, Sweden
- 6LIME, Karolinska Institutet, SE-106 91, Stockholm, Sweden
- 7Public Safety Canada, Ottawa, ON, Canada
- Correspondence: N Långström
- Accepted 15 July 2013
Objective To evaluate the effectiveness of current medical and psychological interventions for individuals at risk of sexually abusing children, both in known abusers and those at risk of abusing.
Design Systematic review of interventions designed to prevent reoffending among known abusers and prevention for individuals at risk of sexually abusing children. Randomised controlled trials and prospective observational studies were eligible. Primary outcomes were arrests, convictions, breaches of conditions, and self reported sexual abuse of children after one year or more.
Results After review of 1447 abstracts, we retrieved 167 full text studies, and finally included eight studies with low to moderate risk of bias. We found weak evidence for interventions aimed at reducing reoffending in identified sexual abusers of children. For adults, evidence from five trials was insufficient regarding both benefits and risks with psychological treatment and pharmacotherapy. For adolescents, limited evidence from one trial suggested that multisystemic therapy prevented reoffence (relative risk 0.18, 95% confidence interval 0.04 to 0.73); lack of adequate research prevented conclusions about effects of other treatments. Evidence was also inadequate regarding effectiveness of treatment for children with sexual behavioural problems in the one trial identified. Finally, we found no eligible research on preventive methods for adults and adolescents who had not sexually abused children but were at higher risk of doing so (such as those with paedophilic sexual preference).
Conclusion There are major weaknesses in the scientific evidence, particularly regarding adult men, the main category of sexual abusers of children. Better coordinated and funded high quality studies including several countries are urgently needed. Until conclusive evidence is available, realistic clinical strategies might involve reduction of specific risk factors for sex crimes, such as sexual preoccupation, in abusers at risk of reoffending.
Contributors: SW, JL, RKH, and NL had the original idea and designed the study, interpreted results, and co-authored the paper. Together with PE and EML, they analysed results and drafted the manuscript. SW and JL managed data. SW is guarantor.
Funding: The Swedish Government, Department of Social Affairs commissioned the systematic review and funded some of the work. The funder had no influence on the process or conclusions of the present work. SW and JL were both employed by the Swedish Council on Health Technology Assessment (SBU). The views expressed are those of the authors and not necessarily those of Public Safety Canada or the Swedish Prison and Probation Administration.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: Not required.
Data sharing: No additional data available.
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