Psychological Medicine

  • Psychological Medicine / Volume 42 / Issue 02 / February 2012, pp 409-417
  • Copyright © Cambridge University Press 2011 The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <>. The written permission of Cambridge University Press must be obtained for commercial re-use.
  • DOI: (About DOI), Published online: 11 August 2011

Original Articles

Childhood sexual abuse and the risk for recurrent major depression in Chinese women

E. Conga1a2, Y. Lia2, C. Shaoa1, J. Chena3, W. Wua4, X. Shanga5, Z. Wanga6, Y. Liua7, L. Liua8, C. Gaoa9, Y. Lia10, J. Wua11, H. Denga12, J. Liua13, W. Sanga14, G. Liua15, H. Ronga16, Z. Gana17, L. Lia18, K. Lia19, J. Pana20, Y. Lia21, Y. Cuia22, L. Suna23, L. Liua24, H. Liua25, X. Zhaoa26, Y. Zhanga27, R. Zhanga28, Y. Chena29, X. Wanga30, H. Lia31, Y. Chena32, Y. Lina33, K. S. Kendlera34, J. Flinta2 c1 and S. Shia1a3 c2

a1 Huashan Hospital, Fudan University, Shanghai, P.R. China

a2 Wellcome Trust Centre for Human Genetics, Oxford, UK

a3 Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China

a4 Tongji Hospital, Shanghai Tongji University, Shanghai, P.R. China

a5 Nanjing Brain Hospital, Nanjing, Jiangsu, P.R. China

a6 No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China

a7 Tianjin Anding Hospital, Hexi District, Tianjin, P.R. China

a8 Shandong Mental Health Centre, Jinan, Shandong, P.R. China

a9 No. 1 Hospital of Medical College of Xian Jiaotong University, Xi'an, Shaanxi, P.R. China

a10 No. 1 Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China

a11 No. 1 Mental Health Centre Affiliated Harbin Medical University, Nangang District, Harbin, Heilongjiang, P.R. China

a12 Mental Health Centre of West China Hospital of Sichuan University, Wu Hou District, Chengdu, Sichuan, P.R. China

a13 Beijing Anding Hospital, Capital Medical University, Xicheng District, Beijing, P.R. China

a14 Hebei Mental Health Centre, Baoding, Hebei, P.R. China

a15 Shengjing Hospital of China Medical University, Heping District Shenyang, Liaoning, P.R. China

a16 Shenzhen Kangning Hospital, Luo Hu, Shenzhen, Guangdong, P.R. China

a17 No. 3 Affiliated Hospital of Sun Yat-sen University, Tian He District, Guangzhou, Guangdong, P.R. China

a18 No. 1 Hospital of Shanxi Medical University, Taiyuan, Shanxi, P.R. China

a19 Mental Hospital of Jiangxi Province, Nanchang, Jiangxi, P.R. China

a20 The First Affiliated Hospital of Jinan University, Tian He District, Guangzhou, Guangdong, P.R. China

a21 Wuhan Mental Health Centre, Wuhan, P.R. China

a22 No. 3 Hospital of Heilongjiang Province, Beian, Heilongjiang, P.R. China

a23 Jilin Brain Hospital, Siping, Jilin, P.R. China

a24 The First Hospital of China Medical University, He Ping District, Shenyang, Liaoning, P.R. China

a25 Dalian No. 7 People's Hospital and Dalian Mental Health Centre, Gan Jing Zi District, Dalian, Liaoning, P.R. China

a26 The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China

a27 Lanzhou University Second Hospital, Second Clinical Medical College of Lanzhou University, Lanzhou, Gansu Province, P.R. China

a28 Psychiatric Hospital of Henan Province, Xinxiang, Henan, P.R. China

a29 The Fourth Military Medical University affiliated Xijing Hospital, Xi'an, Shaanxi, P.R. China

a30 No. 4 People's Hospital of Liaocheng, Liaocheng, Shandong, P.R. China

a31 Guangzhou Brain Hospital/Guangzhou Psychiatric Hospital, Li Wan District, Guangzhou, Guangdong, P.R. China

a32 Clinical Trial Service Unit, Richard Doll Building, Oxford, UK

a33 Fuzhou Neuropsychiatric Hospital, Fuzhou City, Fujian, P.R. China

a34 Department of Psychiatry, Virginia Commonwealth University, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, VA, USA


Background Studies in Western countries have repeatedly shown that women with a history of childhood sexual abuse (CSA) are at increased risk for developing major depression (MD). Would this relationship be found in China?

Method Three levels of CSA (non-genital, genital, and intercourse) were assessed by self-report in two groups of Han Chinese women: 1970 clinically ascertained with recurrent MD and 2597 matched controls. Diagnostic and other risk factor information was assessed at personal interview. Odds ratios (ORs) were calculated by logistic regression and regression coefficients by linear or Poisson regression.

Results Any form of CSA was significantly associated with recurrent MD [OR 3.26, 95% confidence interval (CI) 1.95–5.45]. This association strengthened with increasing CSA severity: non-genital (OR 2.47, 95% CI 1.17–5.23), genital (OR 2.77, 95% CI 1.32–5.83) and intercourse (OR 13.35, 95% CI 1.83–97.42). The association between any form of CSA and MD remained significant after accounting for parental history of depression, childhood emotional neglect (CEN), childhood physical abuse (CPA) and parent–child relationship. Among the depressed women, those with CSA had an earlier age of onset, longer depressive episodes and an increased risk for generalized anxiety disorder (GAD; OR 1.92, 95% CI 1.39–2.66) and dysthymia (OR 2.16, 95% CI 1.52–3.09).

Conclusions In Chinese women CSA is strongly associated with MD and this association increases with greater severity of CSA. Depressed women with CSA have an earlier age of onset, longer depressive episodes and increased co-morbidity with GAD and dysthymia. Although reporting biases cannot be ruled out, our results are consistent with the hypothesis that, as in Western countries, CSA substantially increases the risk for MD in China.

(Received March 02 2011)

(Revised July 06 2011)

(Accepted July 06 2011)

(Online publication August 11 2011)


c1 Address for correspondence: J. Flint, M.D., Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, UK. (Email: [J. Flint]

c2 (Email [S. Shi]