There has been a rapid expansion of interest into the role of childhood trauma in depression over the past 10-15 years. Most studies find associations between recalled trauma, particularly child sexual abuse, and depression. There is, however, a need to establish whether it has a causal role, and if so what are the processes linking the trauma to depression.
Several recent studies have confirmed a high rate of recalled sexual abuse in the general population, of around 18% in women and 5% in men. Recalled sexual abuse has been associated consistently with the diagnosis of depression in both men and women. Much less attention has been paid to the role of physical abuse. These associations hold up in studies that account for genetic influences. However the specific role of child sexual abuse is not yet clear. It is associated with multiple adult psychiatric disorders, and recent studies indicate that it may contribute to some, but not all, pathways to depression. It is likely that psychological, social and neuro-endocrine processes are affected by childhood trauma, and contribute to the risk for depression.
The finding of associations of childhood trauma with depression, together with other adverse childhood experiences, underlines the need for clinicians treating children and adults to take a developmental perspective. The elucidation of different pathways to depression, including childhood adversities, can help to clarify heterogeneity within the broad-brush diagnosis of depression. This should lead to a better understanding of the role of different mechanisms, with implications for early intervention and treatment.
Child and Developmental Psychiatry, University of Liverpool and The Royal Liverpool Children's Hospital, Alder Hey, Liverpool, UK
Correspondence to Jonathan Hill, Professor of Child and Developmental Psychiatry, University of Liverpool and The Royal Liverpool Children's Hospital, Alder Hey, Eaton Road, Liverpool, L12 2AP, UK; Tel: 0151 252 5509; fax: 0151 252 5285; e-mail: firstname.lastname@example.org