Characteristics of depressed patients who report childhood sexual abuse

OBJECTIVE: Depressed patients who had and had not been exposed to childhood sexual abuse were studied to determine differences in severity of depressed mood, lifetime histories of anxiety and depression, childhood environment, and disordered personality function. METHOD: Data were obtained from 269 inpatients and outpatients with major depression (171 women and 98 men) by means of structured clinical interviews and self-report questionnaires. RESULTS: Forty-six of the 269 patients reported childhood sexual abuse; 40 of these were women. These 40 women were compared with the 131 who did not report childhood sexual abuse. The patients who experienced abuse did not differ from those who had not on psychiatrist-rated mood severity estimates, but they did have higher self-report depression scores. They also evidenced more self-destructive behavior, more personality dysfunction, and more overall adversity in their childhood environment. Childhood sexual abuse status was associated with more borderline personality characteristics independently of other negative aspects of the patients' earlier parenting. Childhood sexual abuse status was linked strongly to adult self-destructiveness, as was early exposure to maternal indifference. CONCLUSIONS: Multivariate analyses suggest that depression is unlikely to be a direct consequence of childhood sexual abuse. Childhood sexual abuse appears to be associated with a greater chance of having experienced a broadly dysfunctional childhood home environment, a greater chance of having a borderline personality style, and, in turn, a greater chance of experiencing depression in adulthood.     

Correlates of suicide risk in adolescent inpatients who report a history of childhood abuse

The study objective was to examine correlates of suicide risk in psychiatrically hospitalized adolescents with a reported history of childhood abuse. Predictors of suicide risk were examined in 74 subjects who reported a history of childhood abuse and 53 depressed subjects who did not report a history of childhood abuse. Subjects completed a battery of psychometrically well-established self-report instruments to assess childhood abuse, suicide risk, and internalizing and externalizing psychopathology. Correlational analyses showed that higher levels of depression, self-criticism, and hopelessness were significantly associated with suicide risk in both study groups and violence was significantly associated with suicide risk in the childhood abuse group. For the childhood abuse group, multiple regression analyses with seven predictor variables accounted for 54% of the variance in suicide risk; depression and alcohol problems made significant independent contributions, while violence and self-criticism were independent predictors at the trend level. For the depressed/nonabused group, multiple regression analyses with the seven predictor variables accounted for 60% of the variance in suicide risk; depression, hopelessness, and self-criticism were independent predictors. Our findings suggest that both internalizing (i.e., depression or self-criticism) and externalizing (i.e., violence or alcohol) factors predict suicide risk in adolescent inpatients who report childhood abuse. This profile appears different from the more internalizing pattern (i.e., depression, self-criticism, and hopelessness) observed for the depressed adolescent inpatients who reported no history of childhood abuse.     

Gender differences in depression risk and coping factors in a clinical sample

OBJECTIVE: To examine gender differences in depression risk and coping factors in a clinical sample of patients with a diagnosis of DSM-IV major depression. METHOD: Patients were assessed for substance use and abuse, family history of psychiatric disorder, interpersonal depressogenic factors and lifetime history of anxiety disorders. Trait anxiety, coping styles when depressed, parental bonding, marital features and personality style were also measured. Patients were reassessed at 12-month follow-up. RESULTS: There were few gender differences in experience of depression (either in duration, type or severity prior to treatment) in a group with established episodes of major depression but women reported more emotional arousability when depressed. Women reported higher rates of dysfunctional parenting and childhood sexual abuse, and rated their partners as less caring and as more likely to be a depressogenic stressor. Men were more likely to have a generalized anxiety disorder at assessment, to use recreational drugs prior to presentation. Men were rated as having a more rigid personality style and 'Cluster A' personality traits both at assessment and follow-up. CONCLUSION: There were few gender differences in severity or course of established episodes of major depression. Gender differences were related to levels of arousal, anxiety disorders, and repertoires for dealing with depression, rather than depressive symptoms per se.     

Preliminary report on childhood sexual abuse, suicidal ideation, and suicide attempts among middle-aged and older depressed women.

OBJECTIVE: Authors examined the relationship between childhood sexual abuse histories and suicidal ideation and behavior among depressed women age 50 years and older. METHODS: After admission to a psychiatric unit, participants were administered the Structured Clinical Interview for DSM-III-R and measures of suicidal ideation and behavior. RESULTS: Women who reported abuse histories were more likely to report suicidal ideation at the time of hospitalization and a history of multiple suicide attempts. CONCLUSIONS: These preliminary findings underscore the need for more study of how childhood abuse amplifies risk for suicidal ideation and behavior among women across the life course.     

Psychological consequences for women sexually abused in childhood

Summary Forty-one female volunteers, sexually abused in childhood, were compared to 56 women who had not been sexually abused. The Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), and the Fear Survey Interview (FSI) were utilized to assess the long-term effects of childhood sexual abuse on 41 female volunteers. The abused women's scores were compared to the scores of 56 women who had not been sexually abused. Information was also obtained subjectively from the abused group in the areas of sexuality and interpersonal relationships. Sexually abused women were found to be more depressed, anxious, and fearful than the controls. Fear and distrust of men, and difficulty with sexual functioning were the most common long-term problems cited by the sexually abused women.     

Personality traits of women with a history of childhood sexual abuse

This study examined relationships between specific dimensions of childhood sexual abuse and personality traits in adulthood. Study participants were 74 hospitalized female psychiatric patients with a self-reported history of childhood sexual abuse. Characteristics of childhood sexual abuse were obtained from a structured life-events interview. Personality was measured with the NEO-Five-Factor Inventory (NEO-FFI), which yields scores on neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. We hypothesized that parental abuse, intercourse, and the combination of these two childhood sexual abuse characteristics would be associated with personality traits. Supporting this hypothesis, women who were abused by a parent had lower scores on openness to experience than women who were abused by someone else. Patients whose abuse history included both parental abuse and intercourse had very low extraversion scores. Our findings suggest that there are associations between personality traits and childhood sexual abuse characteristics in psychiatric patients. Specifically, women who experienced intercourse by a parent may be more introverted and less open to experience than women whose sexual abuse history does not include parental incest.     

Child sexual abuse in women who take overdoses: I. A study of prevalence and severity

There is now considerable evidence that people reporting a history of child abuse have an increased prevalence of deliberate self-harm, a term that includes deliberate self-poisoning (overdose) and deliberate self-injury, but little information is available on the prevalence of abuse experiences in those who have harmed themselves. Modified versions of standardised self-report questionnaires of sexual, physical, and psychological abuse were administered to a sample of 257 female patients consecutively admitted over a one year period to a general hospital in England after taking an overdose. This study suggests that sexual abuse is very prevalent in the female overdose population. Seventy-two percent reported some form of sexual abuse, and 51% reported sexual abuse involving attempted or actual penetration. Grand repeaters (five overdoses or more) had been more severely abused for all three types of abuse. They were also more likely to have been sexually abused at a younger age (before age 13), for longer periods, and for the sexual abuse to have occurred again in adulthood. Our results support the view that childhood sexual abuse may place adults at special risk of subsequent overdoses or other deliberate self-injury. Therefore, clinicians should ask about abuse experiences during the routine psychiatric assessment following an overdose, and especially in those who harm themselves repeatedly.     

The protective role of friendship on the effects of childhood abuse and depression

Background: This study explored the relationships between childhood maltreatment (sexual, physical, and emotional abuse, as well as neglect), adult depression, and perceived social support from family and friends. Methods: As part of an NIH‐funded study of risk and resilience at a public urban hospital in Atlanta, 378 men and women recruited from the primary care and obstetrics gynecology clinic waiting areas answered questions about developmental history, traumatic experiences, current relationship support, and depressive symptoms. Results: Childhood emotional abuse and neglect proved more predictive of adult depression than childhood sexual or physical abuse. In females only, perceived friend social support protected against adult depression even after accounting for the contributions of both emotional abuse and neglect. Conclusions: These findings may elucidate the particular importance of understanding the effects that emotional abuse and neglect have on adult depression, and how perceived friendship support may provide a buffer for women with a history of early life stress who are at risk to develop adult depression. Depression and Anxiety, 2009. Published 2008 Wiley‐Liss, Inc.     

Suicidal ideation in depressed postpartum women: Associations with childhood trauma,sleep disturbance and anxiety

BackgroundSuicide is one of the leading causes of death in postpartum women. Identifying modifiable factors related to suicide risk in mothers after delivery is a public health priority. Our study aim was to examine associations between suicidal ideation (SI) and plausible risk factors (experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms) in depressed postpartum women.MethodsThis secondary analysis included 628 depressed mothers at 4–6 weeks postpartum. Diagnosis was confirmed with the Structured Clinical Interview for DSM-IV. We examined SI from responses to the Edinburgh Postnatal Depression Scale-EPDS item 10; depression levels on the Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms (SIGH-ADS); plus sleep disturbance and anxiety levels with subscales from the EPDS and SIGH-ADS items on sleep and anxiety symptoms.ResultsOf the depressed mothers, 496 (79%) ‘never’ had thoughts of self-harm; 98 (15.6%) ‘hardly ever’; and 34 (5.4%) ‘sometimes’ or ‘quite often’. Logistic regression models indicated that having frequent thoughts of self-harm was related to childhood physical abuse (odds ratio-OR = 1.68, 95% CI = 1.00, 2.81); in mothers without childhood physical abuse, having frequent self-harm thoughts was related to sleep disturbance (OR = 1.15, 95% CI = 1.02, 1.29) and anxiety symptoms (OR = 1.11, 95% CI = 1.01, 1.23).DiscussionBecause women with postpartum depression can present with frequent thoughts of self-harm and a high level of clinical complexity, conducting a detailed safety assessment, that includes evaluation of childhood abuse history and current symptoms of sleep disturbance and anxiety, is a key component in the management of depressed mothers.     

Relevance of childhood trauma for later drug dependence

There are various publications on the impact of the experience of violence and abuse during childhood as it relates to future substance abuse. This study aims to examine how childhood abuse differentiated by type and severity, impacts on future potential for substance abuse. Particular attention is paid to specific psychological symptoms and degree of addiction. METHODS: 100 patients being treated for substance abuse completed a questionnaire where they were questioned about a childhood history of sexual, physical and emotional abuse, neglect and family violence. Psychopathology and severity of addiction were assessed using the EuropASI and SCL-90. RESULTS: The results demonstrated that the respondents had been exposed to multiple risk factors in their childhood. The subjects were differentiated into groups according to type of abuse. The type and severity of psychological symptoms were measured by the SCL-90-R. The type and severity of psychosocial and environmental problems were measured by the EuropASI. It was shown that patients with a history of abuse had a significantly higher incidence of symptomatology, particularly of co-morbid psychological conditions. When differentiating victims of abuse by sex, women showed a significantly stronger impairment in 2 categories. These were insecurity in social contact and phobic fear. For all other variables of impairment, there were no differences between men and women. The severity of the various types of abuse was then correlated to the course of the disease. A strong correlation was found between severe forms of abuse where victims were involved in sexual abuse or family violence and future severe psychological symptoms.     

Implications of childhood sexual abuse for adult borderline personality disorder and complex posttraumatic stress disorder

OBJECTIVE: This study examined whether women with a history of early-onset sexual abuse or those with late-onset sexual abuse were more likely to meet diagnostic criteria for both borderline personality disorder and complex posttraumatic stress disorder (PTSD). METHOD: The Revised Diagnostic Interview for Borderlines and the Trauma Assessment Package were administered to 65 women from three outpatient clinics in a metropolitan area. Thirty-eight subjects met criteria for early-onset abuse, while 27 subjects met criteria for late-onset abuse. RESULTS: The diagnoses of both borderline personality disorder and complex PTSD were significantly higher in women reporting early-onset abuse than in those with late-onset abuse. The trauma variables sexual abuse and paternal incest were significant predictors of both diagnoses. CONCLUSIONS: In contrast to those with comorbid diagnoses, some women with a history of childhood sexual abuse may be extricated from the diagnosis of borderline personality disorder and subsumed under that of complex PTSD.     

The psychopathology of bulimic women who report childhood sexual abuse: the mediating role of core beliefs.

Although reported sexual abuse in childhood is associated with bulimic behaviors, less is known about the cognitive factors that explain this association. This study examined the potential role of core beliefs as a mediator in the abuse-bulimia link. Sixty-one bulimic women were interviewed regarding any history of childhood sexual abuse and completed measures of bulimic behaviors, dissociation, depression, and core beliefs. The 21 women who reported a history of childhood sexual abuse had significantly higher levels of several core beliefs and greater levels of psychopathology. Different core beliefs acted as mediators in the relationships between sexual abuse and individual symptoms. The findings support the suggestion that schema-focused cognitive therapy may be useful in working with bulimics, particularly if they have been sexually abused in childhood. Further research is needed to determine the role of core beliefs in mediating the impact of other forms of trauma and how traumas relate to other "escape" behaviors.     

Altered pituitary-adrenal axis responses to provocative challenge tests in adult survivors of childhood abuse

OBJECTIVE: Early adverse life events may predispose individuals to the development of mood and anxiety disorders in adulthood, perhaps by inducing persistent changes in corticotropin-releasing factor (CRF) neuronal systems. The present study sought to evaluate pituitary-adrenal responses to standard hypothalamic-pituitary-adrenal axis challenge tests in adult female survivors of childhood abuse with and without major depressive disorder. METHOD: Plasma ACTH and cortisol responses to the administration of 1 microg/kg ovine CRF and plasma cortisol responses to the administration of 250 microg ACTH(1-24) were measured in healthy women without early life stress (N=20), women with childhood abuse without major depressive disorder (N=20), women with childhood abuse and major depressive disorder (N=15), and women with major depression but no early life stress (N=11). RESULTS: Abused women without major depressive disorder exhibited greater than usual ACTH responses to CRF administration, whereas abused women with major depressive disorder and depressed women without early life stress demonstrated blunted ACTH responses. In the ACTH(1-24) stimulation test, abused women without major depressive disorder exhibited lower baseline and stimulated plasma cortisol concentrations. Abused women with comorbid depression more often suffered from posttraumatic stress disorder and reported more recent life stress than abused women without major depressive disorder. CONCLUSIONS: These findings suggest sensitization of the anterior pituitary and counterregulative adaptation of the adrenal cortex in abused women without major depressive disorder. On subsequent stress exposure, women with a history of childhood abuse may hypersecrete CRF, resulting in down-regulation of adenohypophyseal CRF receptors and symptoms of depression and anxiety.     

Chronic pain syndromes and their relation to childhood abuse and stressful life events

OBJECTIVE: Childhood abuse, stressful life events, and depression have been repeatedly reported to correlate with chronic pain, but little is known about the mutual relationships among these variables. METHODS: Forty-three women with chronic pelvic pain (CPP), 40 female patients with chronic low-back pain (CLBP), and a female pain-free control group (n=22) were investigated by means of a semistructured interview assessing childhood sexual and physical abuse as well as stressful life events. Additionally, the Beck Depression Inventory (BDI) was used. For multivariate analyses, structured equation modeling was applied. RESULTS: Childhood physical abuse, stressful life events, and depression had a significant impact on the occurrence of chronic pain in general, whereas childhood sexual abuse was correlated with CPP only. Moreover, childhood sexual abuse was related to depression. Both childhood sexual and physical abuse showed a close relationship to an increased occurrence of stressful life events. CONCLUSION: There are complex mutual interactions among childhood abuse, stressful life events, depression, and the occurrence of chronic pain. Therefore, clinicians should take into consideration these psychosocial factors while treating chronic pain patients.     

The relationship of childhood abuse to impulsivity and suicidal behavior in adults with major depression.

OBJECTIVE: This study investigated whether a higher frequency of reported childhood trauma would be found in depressed adults with higher levels of trait impulsivity, aggression, and suicidal behavior. METHOD: In 136 depressed adult inpatients, the authors assessed trait impulsivity, aggression history, and number of lifetime suicide attempts as well as the medical lethality and the intent to die associated with the most lethal attempt. These variables were then compared between those with and those without a reported history of childhood physical or sexual abuse. RESULTS: Subjects who reported an abuse history were more likely to have made a suicide attempt and had significantly higher impulsivity and aggression scores than those who did not report an abuse history. Impulsivity and aggression scores were significantly higher in subjects with a history of at least one suicide attempt. A logistic regression analysis revealed that abuse history remained significantly associated with suicide attempt status after adjustment for impulsivity, aggression history, and presence of borderline personality disorder. Among those who attempted suicide, there were no significant differences in severity of suicidal behavior between those with and without a childhood history of abuse. CONCLUSIONS: Abuse in childhood may constitute an environmental risk factor for the development of trait impulsivity and aggression as well as suicide attempts in depressed adults. Alternatively, impulsivity and aggression may be inherited traits underlying both childhood abuse and suicidal behavior in adulthood disorders. Additional research is needed to estimate the relative contributions of heredity and environmental experience to the development of impulsivity, aggression, and suicidal behavior.     

The role of childhood interpersonal trauma in depersonalization disorder.

OBJECTIVE: In contrast to trauma's relationship with the other dissociative disorders, the relationship of trauma to depersonalization disorder is unknown. The purpose of this study was to systematically investigate the role of childhood interpersonal trauma in depersonalization disorder. METHOD: Forty-nine subjects with DSM-IV depersonalization disorder and 26 healthy comparison subjects who were free of lifetime axis I and II disorders and of comparable age and gender were administered the Dissociative Experiences Scale and the Childhood Trauma Interview, which measures separation or loss, physical neglect, emotional abuse, physical abuse, witnessing of violence, and sexual abuse. RESULTS: Childhood interpersonal trauma as a whole was highly predictive of both a diagnosis of depersonalization disorder and of scores denoting dissociation, pathological dissociation, and depersonalization. Emotional abuse, both in total score and in maximum severity, emerged as the most significant predictor both of a diagnosis of depersonalization disorder and of scores denoting depersonalization but not of general dissociation scores, which were better predicted by combined emotional and sexual abuse. The majority of the perpetrators of emotional abuse were either or both parents. Although different types of trauma were modestly correlated, only a few of these relationships were statistically significant, underscoring the importance of comprehensively considering different types of trauma in research studies. CONCLUSIONS: Childhood interpersonal trauma and, in particular, emotional abuse may play a role in the pathogenesis of depersonalization disorder. Compared to other types of childhood trauma, emotional maltreatment is a relatively neglected entity in psychiatric research and merits more attention.     

Childhood abuse and lifetime psychopathology in a community sample.

OBJECTIVE: The authors assessed lifetime psychopathology in a general population sample and compared the rates of five psychiatric disorder categories between those who reported a childhood history of either physical or sexual abuse and those who did not. METHOD: A modified version of the Composite International Diagnostic Interview and a self-completed questionnaire on child abuse were administered to a probability sample (N=7,016) of Ontario residents 15 to 64 years of age. RESULTS: Those reporting a history of childhood physical abuse had significantly higher lifetime rates of anxiety disorders, alcohol abuse/dependence, and antisocial behavior and were more likely to have one or more disorders than were those without such a history. Women, but not men, with a history of physical abuse had significantly higher lifetime rates of major depression and illicit drug abuse/dependence than did women with no such history. A history of childhood sexual abuse was also associated with higher rates of all disorders considered in women. In men, the prevalence of disorders tended to be higher among those who reported exposure to sexual abuse, but only the associations with alcohol abuse/dependence and the category of one or more disorders reached statistical significance. The relationship between a childhood history of physical abuse and lifetime psychopathology varied significantly by gender for all categories except for anxiety disorders. Although not statistically significant, a similar relationship was seen between childhood history of sexual abuse and lifetime psychopathology. CONCLUSIONS: A history of abuse in childhood increases the likelihood of lifetime psychopathology; this association appears stronger for women than men.     

Psychological defense styles in women who report childhood sexual abuse: a controlled community study.

OBJECTIVE: The psychological defense styles of women who reported childhood sexual abuse were assessed and compared to those of women without childhood sexual abuse. METHOD: Subjects in a random community sample (N = 354) of New Zealand women were interviewed and completed two relevant questionnaires, the Defense Style Questionnaire and the Dissociative Experiences Scale. RESULTS: Women reporting childhood sexual abuse showed more immature defense styles, and those who experienced the most severe childhood sexual abuse showed the most immature styles. Dissociation, however, as measured on the Dissociative Experiences Scale, was not linked to childhood sexual abuse. CONCLUSIONS: Reporting childhood sexual abuse was associated with more immature coping styles, although not dissociation, in this community sample of women. Coping styles are likely to be a major mechanism through which childhood sexual abuse increases rates of later psychological problems.     

Childhood sexual abuse and later psychological problems: neither necessary,sufficient nor acting alone

This study aimed to examine the relationships between childhood sexual abuse (CSA) and other adverse development factors and a range of adverse adult psychological and socioeconomic outcomes. Postal questionnaires were sent to a random community sample of women with a screen included for CSA. Two hundred and fifty-four women who reported CSA were interviewed as well as an equal-sized control group with no CSA. A range of negative outcomes in adulthood were more likely to occur in women reporting CSA compared with controls. These outcomes included psychiatric disorder, lowered self-esteem, deliberate self-harm, increased sexual problems, adolescent pregnancy, difficulties in intimate relationships, decline in socioeconomic status and increased likelihood of separation or divorce. The results after logistic regression modelling demonstrated that a variety of childhood risk factors such as poor parental mental health, relationship to parents and being physically punished as well as CSA contributed to negative adult outcomes. The precise patterns varied for each negative outcome. It was concluded that CSA is best conceptualised as a non-specific risk factor for a wide range of adverse psychological and social adult outcomes. It is frequently found in families which have other risk factors for adverse outcomes. Copyright © 1997 Whurr Publishers Ltd.     

History of childhood abuse in panic disorder,social phobia,and generalized anxiety disorder

The authors examined the prevalence of self-reported childhood physical or sexual abuse in a sample of adult patients presenting for treatment of panic disorder, social phobia, or generalized anxiety disorder. Regardless of the presence of comorbid anxiety disorders or comorbid depression, patients with panic disorder had significantly higher rates of past childhood physical or sexual abuse than patients with social phobia. Patients with generalized anxiety disorder had intermediate rates of past physical or sexual abuse that were not significantly different from the other two diagnostic groups. Anxiety disorder patients with a history of childhood abuse were also more likely to have comorbid major depression than those without. These findings are discussed in terms of biological and behavioral factors that may influence the development of anxiety disorders after the experience of a traumatic event.