Length of Time Between Onset of Childhood Sexual Abuse and Emergence of Depression in a Young Adult Sample: A Retrospective Clinical Report
J Clin Psychiatry 2009;70(5):684-691
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Objective: Depression is the most common adult outcome of exposure to childhood sexual abuse (CSA). In this study, we retrospectively assessed the length of time from initial abuse exposure to onset of a major depressive episode.
Method: A community-based survey of childhood experiences in 564 young adults aged 18 to 22 years, conducted between 1997 and 2001, identified 29 right-handed female subjects with CSA but no other exposure to trauma. Subjects were interviewed for lifetime history and age at onset of Axis I disorders using the Structured Clinical Interview for DSM-IV Axis I Disorders.
Results: Sixty-two percent (N = 18) of the sexual abuse sample met full lifetime criteria for major depressive disorder. Episodes of depression emerged a mean ± SD of 9.2 ± 3.6 years after onset of exposure to sexual abuse. Mean survival time from onset of abuse to onset of depression for the entire sample was 11.47 years (95% CI = 9.80 to 13.13 years). There was a surge in new cases between 12 and 15 years of age. Mean ± SD time to onset of posttraumatic stress disorder was 8.0 ± 3.9 years.
Conclusion: Exposure to CSA appears to sensitize women to the development of depression and to shift age at onset to early adolescence. Findings from this formative study suggest that clinicians should not interpret the absence of symptoms at the time of CSA as a sign of resilience. Continued monitoring of victims of CSA as they pass through puberty is recommended. Reasons for the time lag between CSA and depression are proposed along with potential strategies for early intervention.