From surviving to thriving: factors associated with complete mental health among childhood sexual abuse survivors



Despite many negative health and social consequences of childhood sexual abuse (CSA), some of those with a history of adversity manage to thrive in adulthood and achieve complete mental health (CMH). CMH is defined as the absence of mental illness in combination with almost daily happiness and/or life satisfaction, as well as high levels of social and psychological well-being. The objectives of this study were (1) to identify the pathways linking CSA to CMH in adulthood and (2) to estimate the magnitude of risk and protective factors associated with CMH among those exposed to CSA.


A sample of 17,014 respondents aged 20 years and older from the 2012 Canadian Community Health Survey-Mental Health was selected including 651 with a history of CSA. Path analysis was used to estimate indirect and direct pathways between CSA, a priori hypothesized risk and protective factors, and CMH. Multivariable logistic regression was then used to investigate the magnitude of effects of the same risk and protective factors on CMH among CSA survivors.


After controlling for age, sex, race, education, and marital status, the association between CSA and CMH was mediated by lifetime depression, anxiety, substance abuse, chronic pain, and having a confidant. The strongest predictor of past-year CMH among those with a history of CSA was lifetime depression (OR 0.12, 95% CI 0.07–0.20) followed by having a confidant (OR 6.78, 95% CI 1.89–24.38). The odds of CMH was decreased by over three times among those with a history of substance misuse, and halved for those with lifetime anxiety and/or presence of pain.


These findings suggest that CMH among survivors of CSA is related to social and emotional factors such as social support and lifetime history of mental health conditions. Future research should investigate the effectiveness of multilevel interventions for promoting recovery among CSA survivors.

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The authors would like to thank Philip Baiden, Bailey Hollister, and Raphael Nahar Riviere for their assistance with manuscript preparation and SSHRC for funding this project.


This work was supported by the Social Sciences and Humanities Research Council Grant # 435-2016-0660 (PI: Esme Fuller-Thomson). The views are solely those of the authors.

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Fuller-Thomson, E., Lacombe-Duncan, A., Goodman, D. et al. From surviving to thriving: factors associated with complete mental health among childhood sexual abuse survivors. Soc Psychiatry Psychiatr Epidemiol 55, 735–744 (2020).

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  • Childhood maltreatment
  • Positive psychology
  • Childhood sexual abuse
  • Adverse childhood experiences