Time may not heal all wounds when it comes to childhood sexual abuse. Older
depressed women who experienced childhood sexual abuse prior to the age of 18
appear more likely to contemplate suicide or to have attempted suicide than
same-age depressed women who do not have a history of sexual abuse, according
to a report in the October American Journal of Geriatric
"This study suggests that it is important for clinicians to think
about and be aware of the value of asking older patients about a history of
sexual abuse," lead author Nancy Talbot, Ph.D., told Psychiatric
Talbot said the study is the first to look at the effects on older women of
childhood sexual abuse; attention has largely been focused on its effects on
women in adolescence and early adulthood, she said.
"Many times with older hospitalized adults we may minimize the impact
of early life experiences," Talbot said. "Adult life proceeds, and
you accumulate more and more experience, and there is only so much the
clinician can account for and think about with the patient."
Added to this is the likelihood that older women will not bring the subject
up unless they are specifically asked, she said.
Talbot is an associate professor of psychiatry at the University of
Rochester School of Medicine and Dentistry.
In the study, Talbot and colleagues evaluated 127 women over the age of 50
who were admitted to a psychiatric unit with a diagnosis of major depression.
Of those, 18 women reported having experienced sexual abuse in their youth,
defined as "unwanted sexual contact before age 18."
Of the 18, 15 (83 percent) had attempted suicide in their lifetime, and 12
(67 percent) had made multiple attempts. By comparison, 58 percent of women
with major depression who had not experienced childhood sexual abuse reported
at least one attempt in their lifetime, and 27 percent reported multiple
The abused women were also much more likely to have experienced suicidal
ideation than those who had not been abused (67 percent versus 18
Suicide attempts and suicidal ideation were assessed according to the Scale
of Suicidal Ideation, a 19-item, observer-rated measure of morbid and suicidal
thinking administered in the week prior to interview or in the interval
between a suicide attempt and the interview, whichever is shorter.
Data on sexual abuse history were derived from chart reviews of responses
to the Structured Clinical Interview for DSM-IV Axis I Disorders
Those with a history of sexual abuse were also more likely to have at least
one other Axis 1 diagnosis and a lifetime history of substance abuse.
"Perhaps sexual abuse amplifies the risk for a persistent desire for
escape and cessation of psychic pain proceeding well into middle-age and older
adulthood, marked by a history of chronic suicide ideation and multiple
suicide attempts," Talbot and colleagues wrote in the AJGP
The study was supported by grants from the U.S. Public Health Service.
An abstract of the study, "Preliminary Report on Childhood
Sexual Abuse, Suicidal Ideation, and Suicide Attempts Among Middle-Aged and
Older Depressed Women," is posted online at<http://ajgp.psychiatryonline.org/cgi/content/abstract/12/5/536>.▪
Am J Geriatr Psychiatry