title: Childhood sexual abuse and the risk for recurrent major depression in Chinese women.
abstract: BACKGROUND
  Studies in Western countries have repeatedly shown that women with a history of childhood sexual abuse (CSA) are at increased risk for developing major depression (MD). Would this relationship be found in China?
  
  
  METHODS
  Three levels of CSA (non-genital, genital, and intercourse) were assessed by self-report in two groups of Han Chinese women: 1970 clinically ascertained with recurrent MD and 2597 matched controls. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression and regression coefficients by linear or Poisson regression.
  
  
  RESULTS
  Any form of CSA was significantly associated with recurrent MD [OR 3.26, 95% confidence interval (CI) 1.95-5.45]. This association strengthened with increasing CSA severity: non-genital (OR 2.47, 95% CI 1.17-5.23), genital (OR 2.77, 95% CI 1.32-5.83) and intercourse (OR 13.35, 95% CI 1.83-97.42). The association between any form of CSA and MD remained significant after accounting for parental history of depression, childhood emotional neglect (CEN), childhood physical abuse (CPA) and parent-child relationship. Among the depressed women, those with CSA had an earlier age of onset, longer depressive episodes and an increased risk for generalized anxiety disorder (GAD; OR 1.92, 95% CI 1.39-2.66) and dysthymia (OR 2.16, 95% CI 1.52-3.09).
  
  
  CONCLUSIONS
  In Chinese women CSA is strongly associated with MD and this association increases with greater severity of CSA. Depressed women with CSA have an earlier age of onset, longer depressive episodes and increased co-morbidity with GAD and dysthymia. Although reporting biases cannot be ruled out, our results are consistent with the hypothesis that, as in Western countries, CSA substantially increases the risk for MD in China.
authors.affiliation: Huashan Hospital, Fudan University, Shanghai, P.R. China.
authors.forename: E
authors.initials: E
authors.lastname: Cong
authors.affiliation: Wellcome Trust Centre for Human Genetics, Oxford, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.affiliation: Huashan Hospital, Fudan University, Shanghai, P.R. China.
authors.forename: C
authors.initials: C
authors.lastname: Shao
authors.affiliation: Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.affiliation: Tongji Hospital, Shanghai Tongji University, Shanghai, P.R. China.
authors.forename: W
authors.initials: W
authors.lastname: Wu
authors.affiliation: Nanjing Brain Hospital, Nanjing, Jiangsu, P.R. China.
authors.forename: X
authors.initials: X
authors.lastname: Shang
authors.affiliation: No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China.
authors.forename: Z
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Tianjin Anding Hospital, Hexi District, Tianjin, P.R. China.
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Shandong Mental Health Centre, Jinan, Shandong, P.R. China.
authors.forename: L
authors.initials: L
authors.lastname: Liu
authors.affiliation: No. 1 Hospital of Medical College of Xian Jiaotong University, Xi'an, Shaanxi, P.R. China.
authors.forename: C
authors.initials: C
authors.lastname: Gao
authors.affiliation: No. 1 Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.affiliation: No. 1 Mental Health Centre Affiliated Harbin Medical University, Nangang District, Harbin, Heilongjiang, P.R. China.
authors.forename: J
authors.initials: J
authors.lastname: Wu
authors.affiliation: Mental Health Centre of West China Hospital of Sichuan University, Wu Hou District, Chengdu, Sichuan, P.R. China.
authors.forename: H
authors.initials: H
authors.lastname: Deng
authors.affiliation: Beijing Anding Hospital, Capital Medical University, Xicheng District, Beijing, P.R. China.
authors.forename: J
authors.initials: J
authors.lastname: Liu
authors.affiliation: Hebei Mental Health Centre, Baoding, Hebei, P.R. China.
authors.forename: W
authors.initials: W
authors.lastname: Sang
authors.affiliation: Shengjing Hospital of China Medical University, Heping District Shenyang, Liaoning, P.R. China.
authors.forename: G
authors.initials: G
authors.lastname: Liu
authors.affiliation: Shenzhen Kangning Hospital, Luo Hu, Shenzhen, Guangdong, P.R. China.
authors.forename: H
authors.initials: H
authors.lastname: Rong
authors.affiliation: No. 3 Affiliated Hospital of Sun Yat-sen University, Tian He District, Guangzhou, Guangdong, P.R. China.
authors.forename: Z
authors.initials: Z
authors.lastname: Gan
authors.affiliation: No. 1 Hospital of Shanxi Medical University, Taiyuan, Shanxi, P.R. China.
authors.forename: L
authors.initials: L
authors.lastname: Li
authors.affiliation: Mental Hospital of Jiangxi Province, Nanchang, Jiangxi, P.R. China.
authors.forename: K
authors.initials: K
authors.lastname: Li
authors.affiliation: The First Affiliated Hospital of Jinan University, Tian He District, Guangzhou, Guangdong, P.R. China.
authors.forename: J
authors.initials: J
authors.lastname: Pan
authors.affiliation: Wuhan Mental Health Centre, Wuhan, P.R. China.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.affiliation: No. 3 Hospital of Heilongjiang Province, Beian, Heilongjiang, P.R. China.
authors.forename: Y
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Jilin Brain Hospital, Siping, Jilin, P.R. China.
authors.forename: L
authors.initials: L
authors.lastname: Sun
authors.affiliation: The First Hospital of China Medical University, He Ping District, Shenyang, Liaoning, P.R. China.
authors.forename: L
authors.initials: L
authors.lastname: Liu
authors.affiliation: Dalian No. 7 People's Hospital and Dalian Mental Health Centre, Gan Jing Zi District, Dalian, Liaoning, P.R. China.
authors.forename: H
authors.initials: H
authors.lastname: Liu
authors.affiliation: The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China.
authors.forename: X
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Lanzhou University Second Hospital, Second Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province, P.R. China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Psychiatric Hospital of Henan Province, Xinxiang, Henan, P.R. China.
authors.forename: R
authors.initials: R
authors.lastname: Zhang
authors.affiliation: The Fourth Military Medical University affiliated Xijing Hospital, Xi'an, Shaanxi, P.R. China.
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.affiliation: No. 4 People's Hospital of Liaocheng, Liaocheng, Shandong, P.R. China.
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.affiliation: Guangzhou Brain Hospital/Guangzhou Psychiatric Hospital, Li Wan District, Guangzhou, Guangdong, P.R. China.
authors.forename: H
authors.initials: H
authors.lastname: Li
authors.affiliation: Clinical Trial Service Unit, Richard Doll Building, Oxford, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Fuzhou Neuropsychiatric Hospital, Fuzhou City, Fujian, P.R. China.
authors.forename: Y
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Psychiatry, Virginia Commonwealth University, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Kendler
authors.affiliation: Wellcome Trust Centre for Human Genetics, Oxford, UK.
authors.forename: J
authors.initials: J
authors.lastname: Flint
authors.affiliation: Huashan Hospital, Fudan University, Shanghai, P.R. China.
authors.forename: S
authors.initials: S
authors.lastname: Shi
mesh_terms: D000328:Adult; D017668:Age of Onset; D002648:Child; D002650:Child Abuse, Sexual / Q000145:classification / Q000523:psychology* / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D012306:Risk