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Clarifying the causal relationship in women between childhood sexual abuse and lifetime major depression

Published online by Cambridge University Press:  13 August 2013

K. S. Kendler  and
S. H. Aggen
K. S. Kendler*
Affiliation:
Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA Department of Human and Molecular Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
S. H. Aggen
Affiliation:
Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
*
* Address for correspondence: K. S. Kendler, M.D., Virginia Institute for Psychiatric and Behavioral Genetics of VCU, Box 980126, Richmond, VA 23298-0126, USA. (Email: [email protected])
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Abstract

Background

Childhood sexual abuse (CSA) is strongly associated with risk for major depression (MD) but the degree to which this association is causal remains uncertain.

Method

We applied structural equation modeling using the Mplus program to 1493 longitudinally assessed female twins from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders.

Results

Our model included (i) retrospective self- and co-twin reports on CSA, (ii) major potentially confounding covariates, (iii) assessment of lifetime history of MD at two separate interviews, and (iv) mood-congruent recall (implemented by allowing current depressive symptoms to predict reporting of CSA). In a model with only measurement error, CSA explained 9.6% of MD. Including four key covariates reduced the variance explained to 5.3%, with the largest effects found for parental loss and low parental warmth. Adding the effect of mood-congruent recall to a final well-fitting model reduced the percentage of variance explained in lifetime MD (LTMD) by CSA to 4.4%. In this model, current depressive symptoms significantly predicted recall of CSA.

Conclusions

In a model correcting for measurement error, confounding and the impact of mood-congruent recall, CSA remains substantially associated with the risk for LTMD in women. These findings strongly suggest, but do not prove, that this association is causal, and are consistent with previous results in this sample using a co-twin control design, but also indicate that more than half of the uncorrected CSA–MD association is probably not causal. Traumatic life experiences contribute substantially to the risk for LTMD.

Keywords

Causal relationshipchildhood sexual abusemajor depressionmood-congruent recall
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 6 , April 2014 , pp. 1213 - 1221
Copyright
Copyright © Cambridge University Press 2013 

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