Am J Psychiatry 161:1417-1425, August 2004
© 2004 American Psychiatric Association
Implications of Childhood Trauma for Depressed Women: An Analysis of Pathways From Childhood Sexual Abuse to Deliberate Self-Harm and Revictimization
Gemma L. Gladstone, Ph.D., M.A.P.S.,
Gordon B. Parker, M.D., Ph.D., D.Sc., F.R.A.N.Z.C.P.,
Philip B. Mitchell, M.D., F.R.C.Psych., F.R.A.N.Z.C.P.,
Gin S. Malhi, B.Sc., M.R.C.Psych., F.R.A.N.Z.C.P.,
Kay Wilhelm, M.D., F.R.A.N.Z.C.P., and
Marie-Paule Austin, M.D., F.R.A.N.Z.C.P.
OBJECTIVE: Data from depressed women with and without a history of childhood sexual abuse were used to characterize clinical features that distinguished the two groups and to examine relationships of childhood sexual abuse to lifetime deliberate self-harm and recent interpersonal violence. METHOD: One hundred twenty-five women with depressive disorders were interviewed and completed self-report questionnaires. Path analysis was used to examine relationships of several childhood and personality variables with deliberate self-harm in adulthood and recent interpersonal violence. RESULTS: Women with a childhood sexual abuse history reported more childhood physical abuse, childhood emotional abuse, and parental conflict in the home, compared to women without a childhood sexual abuse history. The two groups were similar in severity of depression, but the women with a childhood sexual abuse history were more likely to have attempted suicide and/or engaged in deliberate self-harm. The women with a history of childhood sexual abuse also became depressed earlier in life, were more likely to have panic disorder, and were more likely to report a recent assault. Path analysis confirmed the contributory role of childhood sexual abuse to deliberate self-harm and the significance of childhood physical abuse for recent interpersonal violence. CONCLUSIONS: Childhood sexual abuse is an important risk factor to identify in women with depression. Depressed women with a childhood sexual abuse history constitute a subgroup of patients who may require tailored interventions to combat both depression recurrence and harmful and self-defeating coping strategies.
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