A Developmental Perspective on the Relationship between Child Sexual Abuse and Depression: A Systematic and Meta‐Analytic Review

Abstract

It is essential to examine child sexual abuse (CSA) and depression from a developmental perspective. Two meta‐analyses were conducted to examine the relationship between CSA and depression pertaining to the age at onset. English and Chinese databases were searched for articles on the association between CSA and depression that were published before December 2016. Random effect models were used in the meta‐analyses (35 studies with 37 effect sizes altogether). The result of the first analysis showed that CSA experiences were related to an earlier onset of depression among adult patients with depression with a moderate effect size. This relationship was found to be robust as it was not influenced by any of the moderators except for gender composition of the sample, and no publication bias was detected. The second analysis showed that CSA at a younger age was significantly related to a higher risk for depression in studies with female, adult or clinical/community samples, or where CSA onset was measured as a continuous age variable. The mixed findings between the age at CSA onset and depression caution against the use of a simple linear model. Key Practitioner Messages Screening for child maltreatment experiences should be done routinely for the treatment of depression. Preventive treatment is recommended for young CSA victims even if they do not present with depressive symptoms. Clinicians who work with sexually abused children should consider abuse‐specific treatment to reduce the negative effect of earlier depression onset.

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“…‘CSA experience is significantly related to an earlier onset of depression [among adult patients with depression] with a moderate effect size … which suggested that sexually abused patients were generally more likely to develop depression at an earlier age.’ (Li et al ., , p. 34)…”

“…The first meta‐analysis sought to examine the relationship between CSA experiences and the age at onset of depression. These researchers found that:

‘CSA experience is significantly related to an earlier onset of depression [among adult patients with depression] with a moderate effect size … which suggested that sexually abused patients were generally more likely to develop depression at an earlier age.’ (Li et al ., , p. 34)

Their meta‐analysis was based on 13 papers with a total of 8652 patients with depressive disorders. They also found that the only significant moderating relationship was gender, with studies having more females in them reporting larger effect sizes.…”

“…In the second meta‐analysis, Li et al . () sought to examine the relationship between the age at CSA onset and the development of depression. This meta‐analysis was based on 23 studies with a combined total of 3340 CSA victims.…”

“…The researchers found that when different study characteristics were taken into account findings were inconsistent:

‘Earlier CSA onset was found to be significantly related to the risk for depression with a small‐to‐moderate effect size in studies using female, adult or clinical/community samples and where CSA onset was measured as a continuous age variable. In contrast, this relationship was not found in studies with mixed‐gender, younger age or student samples and where CSA onset was measured as a categorical developmental stage.’ (Li et al, , p. 40)

The researchers highlight that the mixed findings associated with the age at CSA onset and depression ‘caution against the use of a simple linear model’ (Li et al ., , p. 40), and they advise that further research studies are required to investigate the relationship between CSA at different developmental time periods and depression. However, Li et al .…”

“…However, Li et al . 's () findings have important implications for those working with sexually abused children and young people as they advocate the importance of preventive treatment ‘for young CSA victims even if they do not present with depressive symptoms’ (p. 40).…”