Implications of childhood trauma for depressed women: an analysis of pathways from childhood sexual abuse to deliberate self-harm and revictimization.
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.


METHODS
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.
School of Psychiatry, University of New South Wales, Sydney, Australia. g.gladstone@unsw.edu.au
Gemma L
GL
Gladstone
Gordon B
GB
Parker
Philip B
PB
Mitchell
Gin S
GS
Malhi
Kay
K
Wilhelm
Marie-Paule
MP
Austin
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000706:statistics & numerical data; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000706:statistics & numerical data; D015897:Comorbidity; D019548:Crime Victims / Q000706:statistics & numerical data*; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D017579:Domestic Violence / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D009517:New South Wales / Q000453:epidemiology; D010555:Personality Inventory; D012307:Risk Factors; D055502:Secondary Prevention; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000453:epidemiology; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D014754:Violence / Q000706:statistics & numerical data*