Childhood Sexual Abuse And The Risk For Major Depression In Women

Part oneChildhood Sexual Abuse and the Risk for Recurrent Major Depression in Chinese Women Childhood sexual abuse and major depression in ChinaObjective Studies in Western countries have repeatedly shown that women with childhood sexual abuse (CSA) are at increased risk for developing Major Depression (MD). Would this relationship be seen in China?Methods Three levels of CSA (no genital, genital, and intercourse) were assessed by self-report in two groups of Han Chinese women:1,970 clinically ascertained with recurrent MD and 2,597 matched controls in Chinese fifty-three psychiatric hospitals and general hospitals. The interview system developed by Oxford University and Virginia Commonwealth University, was used to do the face-to-face personal structural interview for all the subjects in the project. According to the recurrent depression criteria in DSMIV, the subjects who meet the criteria on recurrent depression were recruited. The situation about major depression, general anxiety disorder, panic disorder,phobia,dysthymia,postpartum depression was assessed for depressed women in the interview. The stressful life events, family history of the depressed women, parental bonding instrument, and social life were assessed for all the subjects. Odds Ratios (ORs) and 95% confidence intervals were calculated by logistic regression and regression coefficients by linear or Poisson regression to decide the association between major depression and childhood sexual abuse. Results Any form of CSA was significantly associated with recurrent MD (OR=3.26,95%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, physical abuse and parental child relation (OR=1.86,95%CI:1.06-3.29). Amongst the depressed women, those with CSA had an earlier age of onset, longer depressive episode 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 comorbidity 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 major depression in China. Part twoThe relation between childhood sexual abuse and family dysfunctionObjective There has been a considerable amount of research into the relationship between childhood sexual abuse and family dysfunction, but almost all has been carried out in Western countries. Little research has addressed this question in China if the family dysfunction is the risk factor for CSA and which factor is most influencing.Methods Childhood sexual abuse was assessed in 1970 major depressed patients and 2597 controls in Chinese fifty-three psychiatric hospitals and general hospitals. Using a protocol developed in collaboration with researchers at Virginia Commonwealth and Oxford Universities, subjects were assessed for quality of parental bonding and childhood physical abuse (CPA) and childhood emotional abuse (CEN). A self-assessment questionnaire on childhood sexual abuse was filled in all subjects. Coefficients, Odds Ratios (ORs) and 95% confidence intervals were calculated by logistic regression between Any CSA and parental children relation, childhood physical abuse and childhood emotional abuse. Ordinal regression was used to assess the relationship between measures of parental children relation, childhood physical abuse, childhood emotional abuse and childhood sexual abuse through ORs and 95% confidence intervalsResults Assessment of the quality of parental relationship in those subjects reporting CSA revealed the following:a negative relation between CSA and mother warmth (OR=0.69,95%CI:0.61-0.79), father warmth(OR=0.75,95%CI:0.67-0.85) was found; a positive relation was found between maternal control and CSA (OR=1.28,95%CI:1.13-1.44). The most severe form of CSA (intercourse) is related to mother control (OR=3.13,95%CI:1.87-5.24) and father control(OR=3.26,95%CI:2.00-5.29). Any CSA was related to childhood physical abuse (OR=6.69,95%CI:4.37-10.26) and childhood emotional neglect (OR=4.65,95%CI:3.30-6.55) positively. The most severe form of CSA is positively related to childhood physical abuse (OR=13.37,95%CI:3.94-13.11) and childhood emotional neglect (OR=7.19;95%CI:3.94-13.11).Conclusions In China, CSA is related to family dysfunction. A lack of parental warmth and increased maternal control predicts the severest CSA. CSA is related to childhood physical abuse and childhood emotional neglect positively. Part threeThe association between childhood sexual abuse with neurosis and stressful life eventsobjective Western findings indicate that childhood sexual abuse is associated with a poor marital relationship in adult life and sensitive to stressful life events and increase the neurosis to cause major depression. This study set out to examine the relationship between childhood sexual abuse and neurosis and stressful life events to explore if it is true in China to cause major depression.Methods Childhood sexual abuse was assessed in 1970 major depressed patients and 2597 controls in Chinese fifty-three psychiatric hospitals and general hospitals. Using a protocol developed in collaboration with researchers at Virginia Commonwealth and Oxford Universities, subjects were assessed for stressful life events and social life and neurosis. A self-assessment questionnaire on childhood sexual abuse was filled in all subjects. Ordinal and logistic regression was used to assess the relationship between measures of personal relationship and childhood sexual abuse, between stressful life events and childhood sexual abuse, between neurosis and childhood sexual abuse to calculate the coefficient, Odds Ratio and 95% confidence intervalsResults Assessment of the quality of marital relationship in those subjects reporting CSA revealed the following:any form of CSA was positively correlated to tension in the marital relationship (OR=1.35,95%CI:1.20-1.52) with disagreement (OR=1.28,95%CI:1.15-1.45) and with demands (OR=1.41,95%CI:1.25-1.59). All these relationships became stronger with increasing severity of CSA and the severest form of CSA is related to tension (OR=3.13,95%CI:1.85-5.26), disagree(OR=2.13,95%CI:3.57-1.27) and demands(OR=4.00,95%CI:2.33-7.14). Any form CSA was related with a personality measure, neurosis (OR=1.10,95%CI:1.07-1.12), and with stressful life events. With increasing severity of CSA, neurosis becomes more severe. Intercourse CSA is related with rape (OR=9.94,95%CI:5.46-18.10).Conclusion Women who experience CSA are prone to have tension in their marriage, with more marital disagreements and demands. CSA increases the level of neurosis and the likelihood of experiencing stressful life events. The increased risk of stressful life events and later poor marital relationships for those who experience CSA may explain in part why they have an increased risk of developing major depression. These results are consistent with those reported in Western studies. Part FourAssessing childhood sexual abuse in ChinaObjective There has been little research assessing the extent and impact of childhood sexual abuse in China. An important first step is choosing an appropriate assessment method. Here this study examines the reliability of a self-assessment questionnaire for childhood sexual abuse in clinical depressed patients and controls. Methods A questionnaire asking about childhood sexual abuse, developed by Martin and revised by Kendler, was chosen. Forty-nine depressed female patients and twenty-one controls were given a childhood sexual abuse questionnaire. Subjects were assessed for the second time through telephone interview after a year. Agreement between the two responses was summarized as a kappa coefficient.Results Test-retest reliability yielded a kappa of 0.71 for the measure of childhood sexual abuse in Chinese depressed patients and controls; test-retest reliability yielded a kappa of 0.64 for the measure of childhood sexual abuse in Chinese depressed patients and 0.91 in Chinese controls.Conclusions Childhood sexual abuse can be reliably assessed in Chinese women using the childhood sexual abuse scale.