anxiety disorder, and major depression (Fergusson et al., 1996). Furthermore, the study estimated the population attributable risk (PAR) for each disorder—namely, the percentage of cases of each disorder that are attributable to child sexual abuse. It found PARs ranging from 9.3 to 18.5 percent, depending on the disorder (Table 5-4). The largest was for conduct disorder: more than 18 percent of cases of conduct disorder would have been eliminated if sexual abuse had not occurred.

Other childhood traumas, apart from sexual or physical abuse, are associated with psychopathology, but the evidence is more limited. Exposure to domestic violence or community violence (as witness or victim) are associated with onset of PTSD and depression (for review, see Margolin and Gordis, 2000). Childhood neglect is associated with PTSD (Widom, 1999), a highly important finding given that neglect is the most common type of childhood maltreatment. Childhood neglect, however, does not appear to be significantly related to depressive disorders (Brown et al., 1999). Parental loss is associated with the development of depression, anxiety disorders, PTSD, and substance disorders (Agid et al., 1999; Kendler et al., 1992; Widom, 1999).

Studies of childhood trauma rarely investigate more than two types of trauma. An exception is the National Comorbidity Survey (Kessler et al., 1997), which found that childhood adversities exert multiplicative effects on the onset of psychopathology. Another noteworthy exception is a large study of primary care patients (n=13,494) by Felitti and coworkers

TABLE 5-4 Childhood Sexual Abuse and Psychopathology

Outcomea

Adjusted Odds Ratiob

Estimated Population Attributable Risk For CSAc

Major depression

5.4

14.0 %

Anxiety disorder

3.2

13.3%

Conduct disorder

11.9

18.5%

Alcohol abuse/dependence

2.7

9.3%

Other substance abuse/dependence

6.6

10.8%

Suicide attempt

5.0

19.5%

aAssessed by the Composite International Diagnostic Interview (CIDI) and by the Self-Report Delinquency Instrument (SRDI, for conduct disorder).

bIntercourse (Attempted/Completed) only, in comparison with no history of CSA after adjustment for covariates.

cCSA=Child Sexual Abuse, defined as non-contact sexual abuse, contact, and intercourse.

SOURCE: Fergusson et al., 1996.



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