Childhood Abuse and Clinical Depression in Adults

Overview

Childhood abuse and neglect is an insidious problem with far-reaching consequences. According to the U.S. Department of Health and Human Services Administration for Children and Families, in 2007 close to 800,000 children were determined to be victims of neglect or abuse. These statistics likely underestimate the actual incidence of abuse because an unknown but significant amount of abuse is never reported or investigated. Abuse has devastating, enduring effects on children. Adults who were abused as children continue to suffer from their childhood trauma. One of the many effects of childhood abuse is treatment-resistant depression.

Types of Abuse

The forms of childhood abuse include neglect, emotional abuse, physical abuse and sexual abuse. The lion's share of abuse and neglect takes place within the home. Younger children and infants are particularly vulnerable as they lack the physical, emotional, verbal and social resources to defend themselves or to obtain help. Emotional abuse and neglect are harder to substantiate legally but have insidious effects on individuals and on society. All forms of childhood abuse cause immediate harm and have lasting effects. In many cases, victims of childhood abuse become perpetrators of abuse, continuing the cycle of abuse and victimization of children.

Effects of Abuse

Children who are abused experience symptoms of trauma, including anxiety, depression, difficulties at school or work, anger, aggression, cognitive and learning deficits, medical illness, social withdrawal, impulsivity, sexual activity at an early age and difficulty maintaining close relationships. Victims of childhood abuse are at higher risk for substance abuse, arrest, incarceration and legal problems.

Physiological effects include impairment of regions of the brain that regulate emotions and memory and sensitization of physiological stress response mechanisms. For example, according to a report in the December 2002 "American Journal of Psychiatry," women with histories of chronic childhood abuse and trauma have a smaller left hippocampus volume--a region of the brain involved in spatial memory--than non-depressed and non-childhood traumatized women. Similarly, women with childhood histories of abuse excrete greater amounts of the stress hormone cortisol in response to stress than do women who do not have childhood trauma. These varied effects of abuse often persist into adulthood.

Researchers at McLean Hospital, the largest psychiatric affiliate of Harvard Medical School, have confirmed that child abuse and neglect can "rewire" the developing brain. When brain circuitry is altered during the formative years it may eventually cause such disorders as anxiety and depression to more readily surface in adulthood.

According to Martin Teicher, MD, PhD, director of the Developmental Biopsychiatry Research Program, "science shows that childhood maltreatment may produce changes in both brain function and structure. These changes are permanent. This is not something people can just get over and get on with their lives."

During the course of their studies, the researchers found that four abnormalities are more likely to be present in victims of child abuse and neglect:

* Changes to the Limbic System, the area of the brain that, together with the hypothalamus, controls hunger, thirst, emotional reactions and biological rhythms. In addition, it coordinates complex activities requiring a sequence of performance steps. Changes to the limbic system can result in epileptic seizures and abnormal electroencephalograms (EEG), usually affecting the left hemisphere of the brain, which is associated with more self-destructive behavior and more aggression.
* Deficient Development of the Left Side of the Brain, which can contribute to depression and impaired memory.
* Impaired Corpus Callosum, the pathway integrating the two hemispheres of the brain, which can result in dramatic shifts in mood and personality.
* Increased Blood Flow in the Cerebellar Vermis, the part of the brain involved in emotion, attention, and regulation of the limbic system, which can disrupt emotional balance.

Sexual abuse is even more harmful than physical abuse.  Adolescents and young adults who were abused or neglected during childhood are more than three times as likely to become depressed or suicidal, according to a study in the Journal of Child Psychiatry (1999). This research study also found that children who are sexually abused are more likely to become depressed or suicidal. Victims of sexual abuse were about six times more likely to attempt suicide; additionally, the risk of repeated suicide attempts was eight times higher than in children who were not sexually abused.  Further, 36 percent of those subjected to sexual abuse were diagnosed with a depressive disorder, compared to a 25 percent rate in victims of all types of child abuse or neglect.

Sexual abuse carries the greatest risk of depression and suicide and this has always been noted in the research.  More than a third, 36 percent of sexually abused youths attempted suicide, compared to 16 percent of physically abused youths.   Six percent of children without a history of abuse reported attempting suicide.

Researchers from this study also found that the incidence of suicide attempts was higher during adolescence. ``Adolescence is the most vulnerable time for sexually abused youths, who are more prone to make repeated suicide attempts,'' the researchers said. Contextual factors such as family conflict, parental substance abuse and illegal activities should be addressed and dealt with in the treatment of depressed and suicidal adolescents who have been neglected in childhood.  Familial, parental and environmental factors are often possible contributors to depression. Familial factors include a poor marriage; parental factors include a low parental involvement; and environmental factors include welfare dependence and other socioeconomic issues.

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