title: Mediators of sexual functioning and marital quality in chronically depressed adults with and without a history of childhood sexual abuse.
abstract: BACKGROUND
  Sexual dysfunction is common among depressed adults. Childhood sexual abuse (CSA) and depressive symptomology are among the risk factors for sexual dysfunction, and these factors may interact to predict adult relationship functioning. Several models have been developed postulating interactions between these variables.
  
  
  OBJECTIVE
  We tested models of the effects of CSA and elucidate the associations between CSA, sexual dysfunction, depression severity, anxiety, and relationship quality in chronically depressed adults.
  
  
  METHODS
  Baseline data from 808 chronically depressed outpatients enrolled in the Research Evaluating the Value of Augmenting Medication with Psychotherapy study were evaluated using structural equation modeling.
  
  
  METHODS
  The Inventory of Depressive Symptomology, self-report version (IDS-SR) assessed depression severity, and the Mood and Anxiety Symptom Questionnaire Anxious Arousal subscale assessed anxiety. Sexual function was assessed with the Arizona Sexual Experiences Scale (ASEX), and the Quality of Marriage Index (QMI) assessed relationship quality for patients in stable relationships.
  
  
  RESULTS
  CSA scores predicted depression severity on the IDS-SR, as well as lower relationship quality and sexual satisfaction. ASEX scores were significantly associated with depression severity but were not correlated with the QMI. Two models were evaluated to elucidate these associations, revealing that (i) depression severity and anxious arousal mediated the relationship between CSA and adult sexual function, (ii) anxious arousal and sexual functioning mediated the association between CSA and depression symptoms, and (iii) when these models were combined, anxious arousal emerged as the most important mediator of CSA on depression which, in turn, mediated associations with adult sexual satisfaction and relationship quality.
  
  
  CONCLUSIONS
  Although CSA predicts lower relationship and sexual satisfaction among depressed adults, the long-term effects of CSA appear to be mediated by depressive and anxious symptoms. It is important to address depression and anxiety symptoms when treating patients with CSA who present with sexual dysfunction or marital concerns.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.
authors.forename: Boadie W
authors.initials: BW
authors.lastname: Dunlop
authors.forename: Eric
authors.initials: E
authors.lastname: Hill
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Johnson
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Klein
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Gelenberg
authors.forename: Barbara O
authors.initials: BO
authors.lastname: Rothbaum
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: James H
authors.initials: JH
authors.lastname: Kocsis
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000503:physiopathology / Q000523:psychology*; D001143:Arousal; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology* / Q000706:statistics & numerical data; D002908:Chronic Disease; D003863:Depression / Q000209:etiology / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008393:Marriage / Q000523:psychology; D008875:Middle Aged; D010549:Personal Satisfaction; D011613:Psychotherapy; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D000928:Antidepressive Agents
keywords: Anxiety; Depression; Marriage; Psychosexual Dysfunctions