Child sexual exploitation in a French child welfare cohort: Maltreatment histories, psychological and behavioural difficulties, and suicidal ideation.

INTRODUCTION: Quantitative evidence on child sexual exploitation (CSE) in child welfare populations remains limited, particularly in France. This study examined CSE, associated maltreatment and psychological difficulties, and its indirect association with suicidal ideation. METHOD: We conducted a retrospective cross-sectional study using case-file data for 1315 youth receiving child protection services in Essonne, France. Logistic regression models were adjusted for age, sex, age at entry into care, and school enrolment. Firth penalized logistic regression was used for restricted comparison, and exploratory mediation analyses used 1000 bootstrap simulations. RESULTS: CSE was identified in 62 youth (4.72%); 27.4% were boys. Youth with CSE were older, entered care later, and were more frequently not enrolled in school. Childhood sexual abuse showed the strongest adjusted association with CSE (aOR = 11.01, 95% CI [6.13-20.32], p < .001). Compared with youth who had experienced sexual abuse without CSE, those with CSE had higher odds of self-harm (Firth OR = 2.89, 95% CI [1.55-5.46]), aggression (Firth OR = 2.76, 95% CI [1.46-5.32]), alcohol use (Firth OR = 9.84, 95% CI [2.10-89.45]), and other substance use (Firth OR = 9.79, 95% CI [3.46-32.68]). In multivariable mediation analysis, CSE statistically accounted for 26.4% of the association between childhood sexual abuse and suicidal ideation (ACME = 0.026, 95% CI [0.007-0.044], p = .004). CONCLUSION: CSE identifies a subgroup with extensive adversity and substantial psychological and behavioural difficulties, supporting gender-inclusive, trauma-informed, and coordinated assessment and intervention.