Childhood sexual abuse increases self-harm in depressed women
August 11, 2004
Depressed women who have suffered sexual abuse as a child appear to represent a unique subgroup who may require tailored intervention to combat both depression recurrence and self-harming behaviors, researchers have found.
"One integrative approach includes group work programs that facilitate the resolution of themes of guilt, isolation, and secrecy," Gemma Gladstone (Prince of Wales Hospital, Randwick, New South Wales, Australia) and colleagues report in the American Journal of Psychiatry.
The researchers studied data from 125 women with depressive disorders, of whom 34 had experienced childhood sexual abuse, to identify clinical features that distinguished those with and without a history of childhood sexual abuse.
While depression severity was similar for the two groups, women who had suffered childhood sexual abuse were more likely to develop depression earlier in life, before the age of 21 years.
The two groups had a similar lifetime prevalence of anxiety disorders, with the exception of panic disorder, which had been diagnosed in 55.9% of those in the childhood sexual abuse group, compared with just 27.5% of the remaining women.
Depressed women who had suffered sexual abuse as a child had a strong propensity toward self-damaging behaviors, Gladstone and co-workers report. In all, 82% of the childhood sexual abuse group had either intentionally hurt themselves or attempted suicide, compared with about half of the women not sexually abused.
As this higher rate of deliberate self-harm cannot be explained in terms of depression severity, the finding "constitutes strong evidence for the key relationship between childhood sexual abuse and subsequent self-harm," the researchers comment.
In contrast, there did not appear to be a direct relationship between childhood sexual abuse and adult victimization, which Gladstone et al suggest may be largely dependent on the presence of childhood physical abuse, either alone or in combination with childhood sexual abuse.
They conclude: "The identification of childhood sexual abuse in patients who present with depression is important because a history of childhood sexual abuse is likely to play a key role in lowering the threshold to both onset and recurrence of depression."
Am J Psychiatry 2004; 161: 1417-1425