A Randomized Effectiveness Trial of Interpersonal Psychotherapy for Depressed Women With Sexual Abuse Histories

Abstract

Objectives Many depressed women seen in community mental health centers (CMHCs) have histories of childhood sexual abuse and are economically disadvantaged. Randomized trials are needed to test the effectiveness of evidence-based interventions in this population and setting. This study compared interpersonal psychotherapy with usual care psychotherapy among women in a CMHC. Methods Among 1,100 women seeking treatment in a CMHC, 230 (21%) had major depression and histories of childhood sexual abuse. Seventy women with major depression and sexual abuse before age 18 were randomly assigned to interpersonal psychotherapy (N=37) or usual care psychotherapy (N=33). Staff clinicians provided all treatments. Participants were assessed at study entry and at ten, 24, and 36 weeks after random assignment. Generalized estimating equations were used to examine change over time. Results Compared with women assigned to usual care, women who received interpersonal psychotherapy had greater reductions in depressive symptoms (Hamilton Rating Scale, p=.05, d=.34; Beck Depression Inventory–II, p=.01, d=.29), posttraumatic stress disorder symptoms (p=.04, d=.76), and shame (p=.002, d=.38). Interpersonal psychotherapy and usual care yielded comparable improvements in social and mental health–related functioning. Conclusions Interpersonal psychotherapy compared favorably to usual care psychotherapy in a CMHC in improving psychiatric symptoms and reducing shame among sexually abused women. However, there is a critical need for continued research to develop more effective treatments for the social and psychiatric sequelae of interpersonal trauma and socioeconomic disadvantage.

Effectiveness of interpersonal psychotherapy-trauma for depressed women with childhood abuse histories.

“…In our pilot study of IPT-T (Talbot et al, 2011), we found that IPT-T was associated with greater reductions in depressive symptoms and PTSD symptoms compared to CP at nine-month follow-up. These results informed the primary hypotheses of this study which were: eight months after randomization, women assigned to IPT-T would be more likely to experience a remission of the presenting major depressive episode (primary endpoint) and report improvements in psychological symptoms (depression, post-traumatic stress) and overall social health (improved social function, perceived support, as well as reduced loneliness, social disability, and perceived negative social exchanges with intimate partners).…”

“…To address the needs of depressed women with childhood sexual abuse histories seen in CMHCs, we made four minor adaptations to the IPT protocol (Talbot & Gamble, 2008). A previous study using IPT with these modifications resulted in significant reductions in depressive symptoms compared to care-as-usual among CMHC patients (Talbot et al, 2011). To enhance generalizability to CMHCs broadly, the first two modifications addressed practical issues when providing care in CMHC settings.…”

“…They are also at elevated risk for morbidity (Talbot et al, 2009) and mortality (Brown et al, 2009) as a consequence of their psychological symptoms (e.g., depression, anxiety, PTSD) and their poor social health (e.g., poor social function, social disability, loneliness, partner conflict, low levels of social support, revictimization; Trickett, Noll & Putnam, 2011). Childhood sexual abuse histories are reported by 20% of the female population in publicly-funded community mental health centers (CMHC) (Talbot et al, 2011). CMHC-based interventions for depressed women with abuse histories are critically needed to reduce psychological symptoms and improve social health.…”

“…More than four decades later, despite the acknowledged need for interventions to address the sequelae of childhood sexual abuse, there remains a paucity of controlled trials of individual psychotherapy (Dorrepaal et al, 2014; Nanni et al, 2012). Outside of our prior study (Talbot et al, 2011), we are aware of no prior controlled trials of psychotherapy for women with major depression and histories of childhood sexual abuse.…”

Trauma and Treatment of Child Sexual Abuse

“…Psychotherapy aids as the first model of a healthy relationship for many victims of sexual abuse [23]. This treatment can offer a model of a healing, nurturing relationship, where the client can discover to experience trust.…”