Childhood Sexual Abuse and Comorbid PTSD and Depression in Impoverished Women
Posttraumatic stress disorder (PTSD) and depression frequently co-occur, with the comorbid condition sometimes referred to as posttraumatic depression. Previous research has suggested that posttraumatic depression in women with a history of childhood sexual abuse (CSA) is associated with more severe psychiatric symptoms, impaired functioning, and suicidality, and it is thus imperative to study the specific elements that may contribute to the severity of this condition. The current study sought to determine the role of negative trauma-related cognitions and PTSD symptom clusters on depression severity for CSA survivors. Data were part of a larger archival database from a randomized controlled trial of the Trauma Recovery and Empowerment Model (TREM) group intervention. All participants in the current study (N = 235) were female survivors of CSA and suffered from comorbid PTSD and depression, and the majority (88%) were African American. At the time of the study, most of these women were unemployed and many were either homeless, lived with family or friends, or lived independently in their own rented home. Participants were given a full battery of measures by means of an interview, including assessments of demographics and trauma history, recent trauma, levels of depressive symptoms, PTSD symptom cluster severity, and negative distorted beliefs following trauma. Results indicated that a more extensive history of CSA was associated with more severe PTSD symptoms. Women who experienced limited CSA reported less severe PTSD symptoms than women who experienced both moderate and severe CSA. There were no significant differences in PTSD and depressive symptoms between moderate and severe CSA. As predicted, there were strong correlations between trauma-related cognition subscales, PTSD symptom clusters, and depression severity. Recent trauma was associated with negative thoughts about the world, but counter to prediction, was not related to PTSD and depression severity. A multiple regression analysis indicated that trauma-related negative cognitions about the self and more severe PTSD arousal and avoidant symptoms significantly predicted depression severity. Findings suggest that although many factors may impact the severity of depression, it is important to focus on trauma-related negative cognitions about the self, PTSD arousal, and PTSD avoidant symptoms when treating female survivors of CSA.
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