Sexual Abuse in Childhood and Later Depression

ABSTRACT & COMMENTARY

Synopsis: Adult women were screened in general practitioners' offices in Ireland using a research interview to identify women with depression. Depressed women were more likely to report a history of sexual abuse during childhood-particularly sexual abuse that involved penetration or attempted penetration.

Source: Cheasty M, et al. BMJ 1998; 316:198-201.

The purpose of this study was to examine the association between sexual abuse in childhood and adult depression in women. Cheasty and colleagues used a two-stage, case detection and case identification design, using the 30-item general health questionnaire and the Beck depression inventory for screening and a structured interview schedule to identify cases of depression. Details of sexual abuse in childhood were elicited retrospectively by a semi-structured interview, and details of social problems were elicited by the social problems questionnaire.

Women presenting to three general practices (middle class suburban, deprived inner city, and rural) in Ireland were eligible; 1189 women were screened, and 237 women were subsequently interviewed. Of the 132 depressed women, 37% reported an experience of sexual abuse when they were younger than 16 years, compared with 23% of the 135 nondepressed women. A positive association existed between the more severe abuse and depression-all those who had experienced penetration were depressed as adults. Cheasty et al conclude that a positive association between child sexual abuse and depression was confirmed, but this was confined to more severe abuse (penetration or attempted penetration).

COMMENT BY JOHN M. LEVENTHAL, MD, FAAP

This study provides additional evidence of the long-term, negative consequences of childhood sexual abuse. It is particularly interesting that women who had a history of attempted or completed penetration were the ones who were most likely to be considered depressed. Other types of mental health outcomes in women have, in general, been found to be associated with sexual abuse during childhood. These outcomes have included post-traumatic stress disorder, poor self-esteem and self-worth, anxiety, dissociative phenomena, substance abuse, eating disorders, and indiscriminate sexual behaviors.

Although Cheasty et al provided no information about whether the women in this study disclosed their abuse to authorities or received mental health counseling during childhood, it is likely that neither occurred frequently. Such information would be helpful to pediatricians. Over the last decade or so, children have been more likely to tell someone about their sexual abuse and are usually referred to counseling. It will be important to obtain follow-up data on such children to determine if the rates of long-term mental health problems in this group are decreased because of counseling received after the disclosure. This is important research that needs to be done. Stay tuned for the answer. (Dr. Leventhal is Professor of Pediatrics, Child Study Center, Yale University School of Medicine.)