A Group Based Psychoeducational Intervention for Partners of Child Sexual Abuse Material Offenders.

Sexual offences against children online, including child sexual abuse material (CSAM), is a violation against human rights and is a growing public health problem all over the world. Relatives of CSAM offenders, inclusive partners, have shown to suffer a range of negative consequences. Several studies have identified a lack of adequate mental health support and emphasize the need for targeted interventions to help individuals process and manage the psychological impact and challenges associated with being a relative to a CSAM offender.

The main questions it aims to answer are:

1. What are the clinical characteristics of female partners of male CSAM offenders?

Guiding questions: 1. Do individuals in this population meet criteria for any psychiatric diagnoses? 2. What types of trauma-related symptoms are present within the population? 3. What is the distribution of the degree of suicide risk (low, medium, high) within the population? 2. Is a psychoeducational group intervention for female partners of male CSAM offenders feasible?

Guiding questions: 1. To what extent is it feasible to recruit enough participants within a reasonable (12 months) timeframe? 2. To what extent is it feasible to offer the group intervention within a reasonable (4 months) timeframe? 3. To what extent do participants complete the intended number of sessions? 4. How do participants perceive the treatment and are they satisfied with it? 5. How do participants experience the intervention? 6. Are there any negative effects associated with participation in the intervention? 3. Does a psychoeducational group intervention for female partners of male CSAM offenders provide any indication of effectiveness?

Guiding questions:

1. Are there any changes in depression- and anxiety symptoms and psychological well-being? 2. Are there any changes in daily functioning?

The study will be conducted at ANOVA, Karolinska University Hospital, Sweden. ANOVA is a multidisciplinary clinic and research unit within sexual medicine, andrology and trans medicine. The clinic has many years of clinical experience in assessment, treatment, and research of pedophilia and other sexual medicine conditions. ANOVA operates PrevenTell, a national helpline and chat service for unwanted sexuality, which is the primary means of reaching the target group.

Potentially eligible participants will be invited to ANOVA at Karolinska University Hospital for an on-site assessment with the research team, including a psychiatrist. During this visit, participants will receive verbal information about the study, written participant information will be provided, and informed consent will be obtained. Participants will then complete questionnaires and other study measurements.

The psychoeducational group intervention will include female partners (n=20), and consists of a total of five sessions, each lasting approximately 90 minutes. To clarify the outcome time frame, the first session is considered Day 1. The sessions are held weekly. The group manual is based on our clinical experience of working with relatives, previous research from other countries, and the results of a qualitative study carried out at ANOVA, Karolinska University Hospital (Adebahr et al, 2025.).

The purpose of the intervention is to increase partners' ability to identify, understand, and manage the emotional, social, and practical stresses associated with being a partner of a CSAM offender; to reduce experiences of isolation and shame through the sharing of experiences with others in similar situations; and to provide increased knowledge about sexual problems and available treatments.

An individual follow-up visit with a therapist will take place at the clinic or via video once the group sessions have been completed.

Data analysis Demographic and clinical characteristics of the participants will be presented descriptively. Quantitative data will be analyzed using descriptive statistics, including the calculation of means and standard deviations or interquartile ranges. Pre- and post- intervention assessments will be conducted to examine changes in secondary outcome measures, providing insight into potential effects of the intervention.

Qualitative data will be analyzed using qualitative content analysis with a descriptive manifest approach.

• Posttraumatic Stress Disorder Checklist (version 5) (PCL-5) [Time frame: screening visit]
• psychiatric symptoms according to DSM-5 criteria [Time frame: screening visit]
• Credibility/Expectancy Questionnaire (CEQ) [Time frame: Day 15 (after session 2)]
• Client Satisfaction Questionnaire (CSQ-8) [Time frame: Day 29 (Post-intervention, session 5)]
• Acceptability and relevance [Time frame: After each session (Day 1, Day 8, Day 15, Day 22, Day 29)]
• The General Health Questionnaire 12 (GHQ -12) [Time frame: screening visit, Day 29 (Post-intervention, session 5), and 3 months after session 5 (i.e., Day 29 + 3 months)]
• Negative Effects Questionnaire (NEQ) [Time frame: Day 29 (Post-intervention, session 5), and 3 months after session 5 (i.e., Day 29 + 3 months)]
• Work and Social Adjustment Scale (WSAS) [Time frame: screening visit, Day 29 (Post-intervention, session 5), and 3 months after session 5 (i.e., Day 29 + 3 months)]
• The Montgomery-Åsberg Depression Rating Scale - Self rating (MADRS-S) [Time frame: screening visit, Day 29 (Post-intervention, session 5), and 3 months after session 5 (i.e., Day 29 + 3 months)]