Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 2;54(15):1-11.
doi: 10.1017/S003329172400268X. Online ahead of print.

Childhood sexual abuse and lifetime depressive symptoms: the importance of type and timing of childhood emotional maltreatment

Lauren M Hutson  1 , Rotem Dan  1   2 , Aliza R Brown  1 , Shiba M Esfand  1 , Valerie Ruberto  1 , Emily Johns  1 , Kaylee E Null  1 , Kyoko Ohashi  2   3 , Alaptagin Khan  2   3 , Fei Du  2   4 , Martin H Teicher  2   3 , Diego A Pizzagalli  1   2   4
Affiliations

Childhood sexual abuse and lifetime depressive symptoms: the importance of type and timing of childhood emotional maltreatment

Lauren M Hutson et al. Psychol Med. .

Abstract

Background: Childhood sexual abuse (CSA) and emotional maltreatment are salient risk factors for the development of major depressive disorder (MDD) in women. However, the type- and timing-specific effects of emotional maltreatment experienced during adolescence on future depressive symptomatology in women with CSA have not been explored. The goal of this study was to fill this gap.

Methods: In total, 203 women (ages 20-32) with current depressive symptoms and CSA (MDD/CSA), remitted depressive symptoms and CSA (rMDD/CSA), and current depressive symptoms without CSA (MDD/no CSA) were recruited from the community and completed self-report measures. Depressive symptoms were assessed using the Beck Depression Inventory (BDI-II) and a detailed maltreatment history was collected using the Maltreatment and Abuse Chronology of Exposure (MACE). Differences in maltreatment exposure characteristics, including multiplicity and severity of maltreatment, as well as the chronologies of emotional maltreatment subtypes were compared among groups. A random forest machine-learning algorithm was utilized to assess the impact of exposure to emotional maltreatment subtypes at specific ages on current depressive symptoms.

Results: MDD/CSA women reported greater prevalence and severity of emotional maltreatment relative to rMDD/CSA and MDD/no CSA women [F(2,196) = 9.33, p < 0.001], specifically from ages 12 to 18. The strongest predictor of current depressive symptoms was parental verbal abuse at age 18 for both MDD/CSA women (variable importance [VI] = 1.08, p = 0.006) and MDD/no CSA women (VI = 0.68, p = 0.004).

Conclusions: Targeting emotional maltreatment during late adolescence might prove beneficial for future intervention efforts for MDD following CSA.

Keywords: adolescence; child sexual abuse; depression; life stress; machine learning.

PubMed Disclaimer

Conflict of interest statement

Over the past 3 years, Dr Pizzagalli has received consulting fees from Boehringer Ingelheim, Compass Pathways, Engrail Therapeutics, Karla Therapeutics, Neumora Therapeutics (formerly BlackThorn Therapeutics), Neurocrine Biosciences, Neuroscience Software, Sage Therapeutics, Sama Therapeutics, and Takeda; he has received honoraria from the American Psychological Association, Psychonomic Society and Springer (for editorial work), and Alkermes; he has received research funding from the Bird Foundation, Brain and Behavior Research Foundation, Dana Foundation, Millennium Pharmaceuticals, NIMH, and Wellcome Leap; he has received stock options from Compass Pathways, Engrail Therapeutics, Neumora Therapeutics, and Neuroscience Software. No funding from these entities was used to support the current work, and all views expressed are solely those of the authors. Dr Teicher created the MACE scale used to collect data on type and timing of exposure to maltreatment used in this study. However, there is no financial conflict as this scale was placed into the public domain and it is fully available and free to use. Dr Teicher has received funding from the National Institute on Drug Abuse, as well as funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Juvenile Bipolar Research Foundation, the ANS Foundation, and the Harvard Brain Science Initiative. Dr Teicher is a Trustee of the Dr Robert E. and Elizabeth L. Kahn Family Foundation (unpaid). He serves on the Board of Directors for the Trauma Research Foundation and on the Scientific Advisory Boards for the Penn State P50 Childhood Adversity CAPSTONE Center, the Juvenile Bipolar Research Foundation, the Words Matter Foundation, and SMARTfit™ (all unpaid). He has received honoraria, and in some cases, travel expenses for presentations from the following organizations: The Frank Porter Graham Child Development Institute, University of North Carolina; Sarah Peyton Resonance Summit; Princeton Health, Penn Medicine; The Trauma Research Foundation; Applied Neuroscience Society of Australasia; McGill-Douglas Hospital; University of Turku, Finland; and the Centre for Child Mental Health, London. Dr Teicher receives royalties from Harvard Health Publishing, and he has received gifts of research equipment from SMARTfit™, All.health, and greenTEG AG. Dr Teicher has provided expert testimony for Romanucci & Blandin, LLC, The Reardon Law Firm, PC, Sgro & Roger, Marci A. Kratter, PC, Deratany & Kosner, and Douglas, Leonard & Garvey, PC. All other authors have no conflicts of interest or relevant disclosures.

Figures

Figure 1.
Figure 1.
Between-group differences in MACE global measures of maltreatment. (A) MDD/CSA women reported greater multiplicity of maltreatment than rMDD/CSA women. (B) MDD/CSA women reported greater severity of maltreatment than rMDD/CSA women and MDD/No CSA women. MDD/No CSA women also reported greater severity of maltreatment than rMDD/CSA women. Significance: *p < .05, **p < .01, ***p < .001.
Figure 2.
Figure 2.
Chronology of emotional maltreatment (PVA, NVEA, PEERVA, and EN) severity and age-specific severity differences. (A) Severity of exposure to parental verbal abuse (PVA) between 1-18 years old. (B) Severity of exposure to parental non-verbal emotional abuse (NVEA) between 1-18 years old. (C) Severity of exposure to peer verbal abuse (PEERVA) between 1-18 years old. (D) Severity of exposure to emotional neglect (EN) between 1-18 years old. (E) MDD/CSA women reported greater severity of total emotional maltreatment than rMDD/CSA women (Sidak; p < .001) and MDD/No CSA women (Sidak; p = .007). MDD/CSA women specifically reported greater severity of emotional maltreatment than MDD/No CSA and rMDD/CSA women from ages 12 to 18 years old. Significance for MDD/CSA and rMDD/CSA comparisons: *p < .05, **p < .01, ***p < .001. Significance for MDD/CSA and MDD/No CSA comparisons: †p < .05, ††p < .01, †††p < .001. Abbreviations: PVA = Parental Verbal Abuse, NVEA = Parental Nonverbal Emotional Abuse, PEERVA = Peer Verbal Abuse, EN = Emotional Neglect.
Figure 3.
Figure 3.
Strongest predictors of depressive symptoms in MDD/No CSA and MDD/CSA women. Dose-response curves of emotional maltreatment severity and current depressive symptoms indicating importance of type and timing of maltreatment on current depressive symptoms derived from the random forest regression with conditional interference trees. (A) For MDD/No CSA women, the strongest predictors of depressive symptoms were PVA at age 18 (VI = 0.68; p = .004), PVA at age 16 (VI = 0.56; p = .007), and MACE MULT (VI = 1.09; p = .014). Depressive symptoms increased as severity of each of these maltreatment predictors increased. (B) For MDD/CSA women, the strongest predictors of depressive symptoms were highest level of education completed (VI = 1.34; p = .005), PVA at age 18 (VI = 1.08; p = .006), PVA at age 16 (VI = 1.14; p = .009), and MACE SUM (p = .012). Depressive symptoms decreased as the level of education completed decreased. Depressive symptoms increased as severity of maltreatment predictors (MACE_PVA_18, MACE_PVA_16, and MACE_SUM) increased. Abbreviations: PVA = Parental Verbal Abuse; MULT = Multiplicity; SUM = Total Severity.
See this image and copyright information in PMC

References

    1. Amédée, L. M., Tremblay-Perreault, A., Hébert, M., & Cyr, C. (2019). Child victims of sexual abuse: Teachers’ evaluation of emotion regulation and social adaptation in school. Psychology in the Schools, 56(7), 1077–1088. 10.1002/pits.22236 - DOI
    1. Bailey, K., Baker, A., McElduff, P., & Kavanagh, D. (2016). The influence of parental emotional neglect on assault victims seeking treatment for depressed mood and alcohol misuse: A pilot study. Journal of Clinical Medicine, 5(10), 88. 10.3390/jcm5100088 - DOI - PMC - PubMed
    1. Baldwin, J. R., Coleman, O., Francis, E. R., & Danese, A. (2024). Prospective and retrospective measures of child maltreatment and their association with psychopathology: A systematic review and meta-analysis. JAMA Psychiatry, 81(8), 769–781. 10.1001/jamapsychiatry.2024.0818 - DOI - PMC - PubMed
    1. Beck, A. T., Steer, R. A., & Brown, G. (1996). Beck Depression Inventory – Second Edition: Manual. San Antonio, TX: The Psychological Corporation.
    1. Breiman, L. (2001). Random forests. Machine Learning, 45(1), 5–32. 10.1023/A:1010933404324 - DOI

LinkOut - more resources