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Lifetime History of Sexual Abuse, Clinical Presentation, and Outcome in a Clinical Trial for Adolescent Depression

J Clin Psychiatry 2004;65:77-83

Objective: To investigate the impact of sexual abuse on clinical presentation and treatment outcome in depressed adolescents.

Method: 107 adolescent outpatients, 13 to 18 years old, with DSM-III-R major depression were randomly assigned to cognitive-behavioral therapy (CBT), systemic behavioral family therapy (SBFT), or nondirective supportive therapy (NST) from Oct. 1, 1991 through May 31, 1995. Subjects were classified on the basis of the presence or absence of lifetime history of sexual abuse. Since only 1 subject assigned to SBFT had a history of sexual abuse, we restricted our analyses to those 72 subjects assigned to either CBT or NST. The impact of lifetime history of sexual abuse on service use, depression, and treatment outcome was examined.

Results: Depressed adolescents with a past history of sexual abuse were more likely, at 2-year follow-up, to have had a psychiatric hospitalization and have a depressive relapse, even controlling for maternal depression, source of referral, race, and treatment assignment. CBT was more efficacious than NST in absence of sexual abuse but was not better than NST in those with a history of sexual abuse.

Conclusion: Sexual abuse is a negative predictor of long-term outcome in adolescent depression. CBT for depression may not be as efficacious for those depressed adolescents with a history of sexual abuse. These findings suggest that a history of sexual abuse should be assessed not only in clinical practice, but also in research studies of depressive outcome. Further work is indicated to understand the relationship between sexual abuse and poor outcome in order to help restore these high-risk youths to an optimal developmental trajectory.