Lifetime History of Sexual Abuse, Clinical Presentation, and Outcome in a Clinical Trial for Adolescent Depression
J Clin Psychiatry 2004;65:77-83
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To investigate the impact of sexual
abuse on clinical presentation and treatment outcome in depressed
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
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.