Interpersonal Psychotherapy for Depressed Women With Sexual Abuse Histories

Talbot, Nancy L.; Conwell, Yeates; O’Hara, Michael W.; Stuart, Scott; Ward, Erin A.; Gamble, Stephanie A.; Watts, Arthur; Tu, Xin

doi:10.1097/01.nmd.0000188987.07734.22

Cited by 38 publications

(58 citation statements)

References 17 publications

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“…Major depression was established through the Structured Clinical Interview for Axis I DSM-IV Disorders (19), and sexual abuse history was established through a structured clinical interview on life events (1). Sexual abuse was defined as before age 18 having any unwanted sexual contact or any sexual contact with a family member who was five or more years older.…”

Section: Methodsmentioning

confidence: 99%

“…On the basis of pilot work with this population (1,31), we recast the fourth interpersonal problem area as “interpersonal patterns” to reflect the persistent interpersonal difficulties often associated with interpersonal trauma. This modification is described elsewhere (31).…”

Section: Methodsmentioning

confidence: 99%

“…In a previous uncontrolled pilot study, we found that interpersonal psychotherapy was well suited to the concerns of depressed women with sexual abuse histories and well received by staff therapists (1). Interpersonal psychotherapy has demonstrated efficacy in improving severe and recurrent depression (15), shown promise for treating PTSD (16,17), and improved clinical outcomes among women with low income and from racial-ethnic minority groups (1,16,18). …”

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confidence: 95%

“…Economically disadvantaged women with major depression and childhood sexual abuse histories constitute a substantial segment of the patient population in publicly funded community mental health centers (CMHCs) (1). The mental health burden of co-occurring major depression and childhood sexual abuse includes elevated risk of chronic and recurrent depression, comorbid posttraumatic stress disorder (PTSD), borderline personality disorder, suicidal behavior, and heightened shame (2–8).…”

mentioning

confidence: 99%

“…In mental health settings, estimates of reported childhood sexual abuse range from 35% to 75% (11). Depression and childhood sexual abuse co-occurred among approximately 25% of treatment-seeking women in a CMHC (1). Women who have been sexually abused are more likely to experience difficulties maintaining stable intimate relationships, poor communication with intimate partners (4), and relationship dissatisfaction (4).…”

mentioning

confidence: 99%

See 4 more Smart Citations

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

Talbot¹,

Chaudron²,

Ward³

et al. 2011

Psychiatric Services

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 95%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

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

Talbot¹,

Chaudron²,

Ward³

et al. 2011

Psychiatric Services

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Attachment and Alliance in the Treatment of Depressed, Sexually Abused Women

Smith¹,

Gamble²,

Cort³

et al. 2011

Depress Anxiety

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Background Depression among women with sexual abuse histories is less treatment responsive than in general adult samples. One contributor to poorer treatment outcomes may be abused women’s difficulties in forming and maintaining secure relationships, as reflected in insecure attachment styles, which could also impede the development of a positive therapeutic alliance. The current study examines how attachment orientation (i.e., anxiety and avoidance) and development of the working alliance are associated with treatment outcomes among depressed women with histories of childhood sexual abuse. Method Seventy women seeking treatment in a community mental health center who had Major Depressive Disorder and a childhood sexual abuse history were randomized to Interpersonal Psychotherapy or treatment as usual. Results Greater attachment avoidance and weaker working alliance were each related to worse depression symptom outcomes; these effects were independent of the presence of comorbid Borderline Personality Disorder and Post-Traumatic Stress Disorder. The effect of avoidant attachment on outcomes was not mediated by the working alliance. Further, working alliance had a stronger effect on depression outcomes in the Interpersonal Psychotherapy group. Conclusion Understanding the influence of attachment style and the working alliance on treatment outcomes can inform efforts to improve treatments for depressed women with a history of childhood sexual abuse.

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Predictors of Treatment Outcomes Among Depressed Women With Childhood Sexual Abuse Histories

et al. 2012

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Background A notable portion (21%) of female patients receiving treatment for depression in community mental health centers (CMHC) has childhood sexual abuse (CSA) histories. Treatment outcomes in this population are heterogeneous; identifying factors associated with differential outcomes could inform treatment development. This exploratory study begins to address the gap in what is known about predictors of treatment outcomes among depressed women with sexual abuse histories. Method Seventy women with major depressive disorder and CSA histories in a CMHC were randomly assigned to Interpersonal Psychotherapy (n = 37) or usual care (n = 33). Using generalized estimating equations, we examined four pre-treatment predictor domains (i.e., sociodemographic characteristics, clinical features, social and physical functioning, and trauma features) potentially related to depression treatment outcomes. Results Among sociodemographic characteristics, Black race/ethnicity, public assistance income, and unemployment were associated with less depressive symptom reduction over the course of treatment. Two clinical features, chronic depression and borderline personality disorder, were also related to less reduction in depressive symptoms across the treatment period. Conclusion Our results demonstrate the clinical relevance of attending to predictors of depressed women with CSA histories being treated in public sector mental health centers. Particular sociodemographic characteristics and clinical features among these women may be significant indicators of risk for relatively poorer treatment outcomes.

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Interpersonal Psychotherapy for Depressed Women With Sexual Abuse Histories

Cited by 38 publications

References 17 publications

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

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

Attachment and Alliance in the Treatment of Depressed, Sexually Abused Women

Predictors of Treatment Outcomes Among Depressed Women With Childhood Sexual Abuse Histories

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