Childhood abuse, depression, and anxiety in adult psychiatric outpatients.

Abstract

Theorists have long thought that negative experiences in childhood (e.g., abuse) may contribute to the development of psychopathology in adolescence and adulthood [e.g., Beck, 1967; Bowlby, 1973, 1980]. More recently, they have hypothesized that different types of childhood abuse may contribute specific vulnerability to certain forms of psychopathology. Specifically, theorists have suggested that childhood emotional abuse may be most strongly related to the development of depression, whereas physical abuse may be most strongly related to the development of anxiety [e.g., Ladd and Ladd, 2001; Rose and Abramson, 1992]. In contrast, childhood sexual abuse appears to be relatively nonspecific in terms of its psychopathological correlates [e.g., Kendler et al., 2000] Despite the number of studies that have examined the long-term correlates of childhood abuse [e.g., Gibb et al., 2001; Kendler et al., 2000; Silverman et al., 1996], no study of which we are aware has directly examined the relative specificity of each form of abuse to depression vs. anxiety in a clinical sample. In this study, we examined the relation between adult psychiatric outpatients’ reports of childhood emotional, physical, and sexual abuse and their current symptoms and diagnoses of depression and anxiety. We hypothesized that reports of childhood emotional abuse would be more strongly related to patients’ current depression than anxiety and that reports of childhood physical abuse would show the opposite pattern. In contrast, we predicted that reports of childhood sexual abuse would demonstrate no evidence of specificity. Participants were 552 psychiatric outpatients (mean age1⁄4 40.59 years, sd1⁄4 14.30; 57.1% women; 87.7% Caucasian). Two hundred seventy-three (49.5%) of the patients received a principal Diagnostic and Statistical Manual, 4th Edition [DSM-IV; American Psychiatric Association (APA), 1994] Axis I diagnosis of a depressive disorder (e.g., major depression and dysthymia). One hundred seventy-seven (32.1%) received a principal Axis I diagnosis of an anxiety disorder (e.g., generalized anxiety disorder or panic). One hundred one (18.3%) of the patients received other diagnoses (e.g., bipolar disorder or substance dependence). All measures were administered as part of the intake assessment. Reports of childhood emotional, physical, and sexual abuse were obtained via three dichotomously coded items. Specifically, patients were asked, ‘‘Did you ever experience emotional or verbal abuse as a child?’’ Similar questions were used to assess for childhood physical or sexual abuse. Patients were also administered the Beck Anxiety Inventory [BAI; Beck et al., 1988], Beck Depression Inventory-II [BDI-II; Beck et al., 1996], and the 24-item Hamilton Rating Scale for Depression [HRSD-24; Guy, 1976; Hamilton, 1960]. Finally, diagnoses of depressive and anxiety disorders were obtained using the Structured Clinical Interview for DSM-IV Axis I Disorders [SCID-I; First et al., 1995]. Descriptive statistics including rates of reported childhood abuse, as well as correlations among the study variables, are presented in Table 1. As can be seen in the table, reports of each type of childhood abuse were significantly related to patients’ symptoms of depression and anxiety. As hypothesized, however, reports of childhood emotional abuse were significantly more strongly correlated with outpatients’ BDIII (Z1⁄4 2.25, P1⁄4.01) and HRSD-24 (Z1⁄4 2.79, P1⁄4.003) scores than with their BAI scores. Also as hypothesized, outpatients’ reports of childhood physical abuse were significantly more strongly correlated with their BAI scores than with their BDI-II (Z1⁄4 1.86, P1⁄4.03) or HRSD-24 (Z1⁄4 1.89, P1⁄4.03) scores. In contrast, the differences in the magnitude of the correlations between outpatients’ reports of childhood sexual abuse and their BAI vs. BDI-II (Z1⁄4 0.42, P1⁄4.34) or HRSD24 (Z1⁄4 0.48, P1⁄4.32) scores were not significant. Next, w analyses were used to examine the relation between patients’ reports of childhood abuse and their diagnoses of depressive vs. anxiety disorders. Patients DEPRESSION AND ANXIETY 17:226–228 (2003)