The Relationship between Adolescent Depression and a History of Sexual Abuse

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INTRODUCTION

Depression among adolescents in general, and female adolescents in particular, has been identified as a major mental health diagnosable disorder (Lahey et al., 1996). It is estimated that 28% of adolescents will have experienced an episode of major depression by age 19 (Lewinsohn, Rohde, & Seeley, 1998). Data from community-based, epidemiological surveys also suggested that nearly 30% of a sample of adolescents aged 14 to 18 had at least one current symptom of major depression (Roberts, Lewinsohn, & Seeley, 1995). Depression rates are steadily increasing among adolescents, with symptoms beginning at earlier ages (Son & Kirchner, 2000). Major depression is also the most prevalent mental disorder affecting young adults. Data from a longitudinal community study showed that overall, 23.7% of the sample met diagnostic criteria for major depression between ages 18 and 26 (Paradis, Reinherz, Giaconia, & Fitzmaurice, 2006). There are marked gender differences in major depression prevalence with females being twice as likely as males to develop depression during adolescence (Hazler & Mellin, 2004).

Depressed adolescents may experience more extreme consequences than depressed adults (Schraedley, Gotlib, & Hayward, 1999). They are more susceptible to later traumatic life events and are more likely to experience depressive occurrences in adulthood (Son & Kirchner, 2000; Stannard, 2000). Depression during adolescence is also of utmost concern as it increases the risk for suicide (Stanard, 2000; Capelli et al., 1995).

The most frequently studied risk factors for depression during adolescence include poor attachments with parents, poor relationships with friends, poor school performance, feelings of hopelessness and/or loneliness, substance abuse, and depression or psychiatric illness in the family (Stanard, 2000; Diego, Sanders, & Field, 2001; Son & Kirchner, 2000). Some studies also identified sexual abuse as a major risk factor for depression. For example, a study of 171 women with major depression found that 40 (23.3%) of them reported childhood sexual abuse. A comparison between abused and non-abused women found that women who were sexually abused did not differ on psychiatrist-rated mood severity estimates, but they did have higher self-report depression scores. They also exhibited more self-destructive behavior and personality dysfunction (Gladstone, Parker, Wilhelm, Mitchell, & Austin, 1999). Another study among 125 women with depressive disorders examined the impact of childhood sexual abuse on severity of depression (Gladstone et al., 2004). Although women who reported childhood sexual abuse did not differ from women without such an experience in severity of depression, they became depressed at an earlier age and were also more likely to have attempted suicide and/or engaged in deliberate self-harm.

Relationship Between Depression and Sexual Abuse

Depression is frequently examined in studies focusing on the consequences of sexual abuse. However, a history of sexual abuse is rarely examined in studies that focus on depression. For example, a recent literature review identified changes in social development, social role expectations, and/or biology as important risk factors that explain depression among adolescents (Hazler & Mellin, 2004). However, the contribution of sexual abuse to adolescent depression was only briefly mentioned. Another study examined depression correlates among 413 adolescent primary care attendees who presented with multiple health issues. Although a variety of demographic and contextual factors such as drug use and exposure to drugs were examined, the impact of sexual abuse was not included. Lastly, an analysis of data from Wave I of the National Longitudinal Study of Adolescent Health examined the associations of depression and suicide with patterns of sex and drug use behaviors. However, the possible impact of sexual abuse on these behaviors was not examined (Hallfors et al. …