Archives of Women's Mental Health

, Volume 18, Issue 5, pp 659–671 | Cite as

History of childhood sexual abuse and risk of prenatal and postpartum depression or depressive symptoms: an epidemiologic review

  • Adaeze C. Wosu
  • Bizu GelayeEmail author
  • Michelle A. Williams
Review Article


The objective of this review is to summarize the literature (and to the extent possible, report the magnitude and direction of the association) concerning history of childhood sexual abuse (CSA) and depression or depressive symptoms among pregnant and postpartum women. Publications were identified through literature searches of seven databases (PubMed, EMBASE, PyscINFO, CINAHL, Web of Science, BIOSIS, and Science Direct) using keywords including “child abuse,” “depression,” “pregnancy,” “prenatal,” “pregnancy,” and “postpartum.” The literature search yielded seven eligible studies on the prenatal period and another seven studies on the postpartum period. All but one prenatal study observed statistically significant positive associations of CSA with depression or depressive symptoms during pregnancy. Findings on the association of CSA with postpartum depression or depressive symptoms were inconsistent; pooled unadjusted and adjusted odds ratios were 1.82 (95 % confidence interval (CI) 0.92, 3.60) and 1.20 (95 % CI 0.81, 1.76). In sum, findings suggest a positive association of history of CSA with depression and depressive symptoms in the prenatal period. Findings on the postpartum period were inconsistent. Clinical and public health implications of evidence from the available literature are discussed, as are desirable study design characteristics of future research.


Childhood sexual abuse Childhood trauma Depression Pregnancy Postpartum 



This research was supported by an award from the National Institutes of Health (NIH), the Eunice Kennedy Shriver Institute of Child Health and Human Development (R01-HD-059835).

Conflicts of interest

The authors declare that they have no conflicts of interest.

Supplementary material

737_2015_533_MOESM1_ESM.docx (18 kb)
Online Resource 1 Search terms used to identify relevant publications (DOCX 18 kb)
737_2015_533_MOESM2_ESM.docx (19 kb)
00 Resource 2 Quality assessment of CSA-depression relationship in studies included in this review (n = 14), using the Newcastle-Ottawa Scale (DOCX 18 kb)


  1. Alvarez-Segura M, Garcia-Esteve L, Torres A, Plaza A, Imaz ML, Hermida-Barros L, San L, Burtchen N (2014) Are women with a history of abuse more vulnerable to perinatal depressive symptoms? A systematic review. Arch Womens Ment Health 17:343–357CrossRefPubMedGoogle Scholar
  2. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn, text revision. American Psychiatric Association, Washington D.CGoogle Scholar
  3. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Washington D.CGoogle Scholar
  4. Andrews G, Corry J, Slade T, Issakidis C, Swanston H (2004) Child sexual abuse. In: Ezzati M, Lopez A, Rodgers A, Murray C (eds) Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors, 2nd edn. World Health Organization, Geneva, pp 1851–1940Google Scholar
  5. Bax L, Yu L-M, Ikeda N, Moons K (2007) A systematic comparison of software dedicated to meta-analysis of causal studies. BMC Med Res Methodol 7:40. doi: 10.1186/1471-2288-7-40 PubMedCentralCrossRefPubMedGoogle Scholar
  6. Benedict MI, Paine LL, Paine LA, Brandt D, Stallings R (1999) The association of childhood sexual abuse with depressive symptoms during pregnancy, and selected pregnancy outcomes. Child Abuse Negl 23:659–670CrossRefPubMedGoogle Scholar
  7. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 103:698–709CrossRefPubMedGoogle Scholar
  8. Bertone-Johnson ER, Whitcomb BW, Missmer SA, Karlson EW, Rich-Edwards JW (2012) Inflammation and early-life abuse in women. Am J Prev Med 43:611–620PubMedCentralCrossRefPubMedGoogle Scholar
  9. Beydoun HA, Beydoun MA, Kaufman JS, Lo B, Zonderman AB (2012) Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: a systematic review and meta-analysis. Soc Sci Med 75:959–975PubMedCentralCrossRefPubMedGoogle Scholar
  10. Bonacquisti A, Geller PA, Aaron E (2014) Rates and predictors of prenatal depression in women living with and without HIV. AIDS Care 26:100–106CrossRefPubMedGoogle Scholar
  11. Borenstein M, Hedges L, Higgins J, Rothstein H (2005) Comprehensive meta-analysis version 2. Biostat, EnglewoodGoogle Scholar
  12. Briere J, Runtz M (1988) Symptomatology associated with childhood sexual victimization in a non-clinical sample. Child Abuse Negl 12:51–59CrossRefPubMedGoogle Scholar
  13. Bublitz MH, Stroud LR (2012) Childhood sexual abuse is associated with cortisol awakening response over pregnancy: preliminary findings. Psychoneuroendocrinology 37:1425–1430PubMedCentralCrossRefPubMedGoogle Scholar
  14. Carballedo A, Lisiecka D, Fagan A, Saleh K, Ferguson Y, Connolly G, Meaney J, Frodl T (2012) Early life adversity is associated with brain changes in subjects at family risk for depression. World J Biol Psychiatry 13:569–578CrossRefPubMedGoogle Scholar
  15. Cicchetti D, Rogosch FA, Toth SL (1998) Maternal depressive disorder and contextual risk: contributions to the development of attachment insecurity and behavior problems in toddlerhood. Dev Psychopathol 10:283–300CrossRefPubMedGoogle Scholar
  16. Cohen MM, Schei B, Ansara D, Gallop R, Stuckless N, Stewart DE (2002) A history of personal violence and postpartum depression: is there a link? Arch Womens Ment Health 4:83–92CrossRefGoogle Scholar
  17. Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, Suri R, Burt VK, Hendrick V, Reminick AM, Loughead A, Vitonis AF, Stowe ZN (2006) Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 295:499–507CrossRefPubMedGoogle Scholar
  18. Courtois CA, Courtois RC (1992) Pregnancy and childbirth as triggers for abuse memories: implications for care. Birth 19:222–223CrossRefPubMedGoogle Scholar
  19. Davidson RJ, McEwen BS (2012) Social influences on neuroplasticity: stress and interventions to promote well-being. Nat Neurosci 15:689–695PubMedCentralCrossRefPubMedGoogle Scholar
  20. de Paz NC, Sanchez SE, Huaman LE, Chang GD, Pacora PN, Garcia PJ, Ananth CV, Qiu C, Williams MA (2011) Risk of placental abruption in relation to maternal depressive, anxiety and stress symptoms. J Affect Disord 130:280–284PubMedCentralCrossRefPubMedGoogle Scholar
  21. Dennis CL, Vigod S (2013) The relationship between postpartum depression, domestic violence, childhood violence, and substance use: epidemiologic study of a large community sample. Violence Against Women 19:503–517CrossRefPubMedGoogle Scholar
  22. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188CrossRefPubMedGoogle Scholar
  23. Dettmer AM, Novak MA, Suomi SJ, Meyer JS (2012) Physiological and behavioral adaptation to relocation stress in differentially reared rhesus monkeys: hair cortisol as a biomarker for anxiety-related responses. Psychoneuroendocrinology 37:191–199PubMedCentralCrossRefPubMedGoogle Scholar
  24. Drury SS, Mabile E, Brett ZH, Esteves K, Jones E, Shirtcliff EA, Theall KP (2014) The association of telomere length with family violence and disruption. Pediatrics 134:e128–e137PubMedCentralCrossRefPubMedGoogle Scholar
  25. Farber EW, Herbert SE, Reviere SL (1996) Childhood abuse and suicidality in obstetrics patients in a hospital-based urban prenatal clinic. Gen Hosp Psychiatry 18:56–60CrossRefPubMedGoogle Scholar
  26. Feng X, Wang L, Yang S, Qin D, Wang J, Li C, Lv L, Ma Y, Hu X (2012) Maternal separation produces lasting changes in cortisol and behavior in rhesus monkeys. Proc Natl Acad Sci U S A 108:14312–14317CrossRefGoogle Scholar
  27. Finestone HM, Stenn P, Davies F, Stalker C, Fry R, Koumanis J (2000) Chronic pain and health care utilization in women with a history of childhood sexual abuse. Child Abuse Negl 24:547–556CrossRefPubMedGoogle Scholar
  28. Frodl T, Carballedo A, Fagan AJ, Lisiecka D, Ferguson Y, Meaney JF (2012) Effects of early-life adversity on white matter diffusivity changes in patients at risk for major depression. J Psychiatry Neurosci 37:37–45PubMedCentralCrossRefPubMedGoogle Scholar
  29. Garabedian MJ, Lain KY, Hansen WF, Garcia LS, Williams CM, Crofford LJ (2011) Violence against women and postpartum depression. J Womens Health (Larchmt) 20:447–453CrossRefGoogle Scholar
  30. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106:1071–1083CrossRefPubMedGoogle Scholar
  31. Glynn LM, Sandman CA (2014) Evaluation of the association between placental corticotrophin-releasing hormone and postpartum depressive symptoms. Psychosom Med 76:355–362CrossRefPubMedGoogle Scholar
  32. Glynn LM, Davis EP, Sandman CA (2013) New insights into the role of perinatal HPA-axis dysregulation in postpartum depression. Neuropeptides 47:363–370CrossRefPubMedGoogle Scholar
  33. Grimstad H, Schei B (1999) Pregnancy and delivery for women with a history of child sexual abuse. Child Abuse Negl 23:81–90CrossRefPubMedGoogle Scholar
  34. Hahn-Holbrook J, Schetter CD, Arora C, Hobel CJ (2013) Placental corticotropin-releasing hormone mediates the association between prenatal social support and postpartum depression. Clin Psychol Sci 1:253–264PubMedCentralCrossRefPubMedGoogle Scholar
  35. Hartmann N, Boehner M, Groenen F, Kalb R (2010) Telomere length of patients with major depression is shortened but independent from therapy and severity of the disease. Depress Anxiety 27:1111–1116CrossRefPubMedGoogle Scholar
  36. Herzog R, Alvarez-Pasquin MJ, Diaz C, Del Barrio JL, Estrada JM, Angel G (2013) Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health 13:154. doi: 10.1186/1471-2458-13-154 PubMedCentralCrossRefPubMedGoogle Scholar
  37. Horan DL, Hill LD, Schulkin J (2000) Childhood sexual abuse and preterm labor in adulthood: an endocrinological hypothesis. Womens Health Issues 10:27–33CrossRefPubMedGoogle Scholar
  38. Hulme PA (2011) Childhood sexual abuse, HPA axis regulation, and mental health: an integrative review. West J Nurs Res 33:1069–1097CrossRefPubMedGoogle Scholar
  39. IntHout J, Ioannidis J, Borm GF (2014) The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res Methodol 18:25. doi: 10.1186/1471-2288-14-25 CrossRefGoogle Scholar
  40. Karabatsiakis A, Kolassa IT, Kolassa S, Rudolph KL, Dietrich DE (2014) Telomere shortening in leukocyte subpopulations in depression. BMC Psychiatry 14:192. doi: 10.1186/1471-244X-14-192 PubMedCentralCrossRefPubMedGoogle Scholar
  41. Kendler KS, Bulik CM, Silberg J, Hettema JM, Myers J, Prescott CA (2000) Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Arch Gen Psychiatry 57:953–959CrossRefPubMedGoogle Scholar
  42. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 51:8–19CrossRefPubMedGoogle Scholar
  43. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 62:593–602CrossRefPubMedGoogle Scholar
  44. Kiecolt-Glaser JK, Gouin JP, Weng NP, Malarkey WB, Beversdorf DQ, Glaser R (2011) Childhood adversity heightens the impact of later-life caregiving stress on telomere length and inflammation. Psychosom Med 73:16–22PubMedCentralCrossRefPubMedGoogle Scholar
  45. Kim DR, Sockol LE, Sammel MD, Kelly C, Moseley M, Epperson CN (2013) Elevated risk of adverse obstetric outcomes in pregnant women with depression. Arch Womens Ment Health 16:475–482CrossRefPubMedGoogle Scholar
  46. Lang AJ, Rodgers CS, Lebeck MM (2006) Associations between maternal childhood maltreatment and psychopathology and aggression during pregnancy and postpartum. Child Abuse Negl 30:17–25CrossRefPubMedGoogle Scholar
  47. Leeners B, Richter-Appelt H, Imthurn B, Rath W (2006) Influence of childhood sexual abuse on pregnancy, delivery, and the early postpartum period in adult women. J Psychosom Res 61:139–151CrossRefPubMedGoogle Scholar
  48. Leeners B, Rath W, Block E, Gorres G, Tschudin S (2014) Risk factors for unfavorable pregnancy outcome in women with adverse childhood experiences. J Perinat Med 42:171–178CrossRefPubMedGoogle Scholar
  49. Lev-Wiesel R, Daphna-Tekoah S (2010) The role of peripartum dissociation as a predictor of posttraumatic stress symptoms following childbirth in Israeli Jewish women. J Trauma Dissociation 11:266–283CrossRefPubMedGoogle Scholar
  50. Lopez WD, Konrath SH, Seng JS (2011) Abuse-related post-traumatic stress, coping, and tobacco use in pregnancy. Obstet Gynecol 40:422–431Google Scholar
  51. Martinussen R, Hayden J, Hogg-Johnson S (2005) A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 44:377–384CrossRefPubMedGoogle Scholar
  52. Massey SH, Lieberman DZ, Reiss D, Leve LD, Shaw DS, Neiderhiser JM (2011) Association of clinical characteristics and cessation of tobacco, alcohol, and illicit drug use during pregnancy. Am J Addict 20:143–150PubMedCentralPubMedGoogle Scholar
  53. Molnar BE, Berkman LF, Buka SL (2001) Psychopathology, childhood sexual abuse and other childhood adversities: relative links to subsequent suicidal behaviour in the US. Psychol Med 31:965–977CrossRefPubMedGoogle Scholar
  54. Noll JG, Schulkin J, Trickett PK, Susman EJ, Breech L, Putnam FW (2007) Differential pathways to preterm delivery for sexually abused and comparison women. J Pediatr Psychol 32:1238–1248CrossRefPubMedGoogle Scholar
  55. Oberman L, Pascual-Leone A (2013) Changes in plasticity across the lifespan: cause of disease and target for intervention. Prog Brain Res 207:91–120PubMedCentralCrossRefPubMedGoogle Scholar
  56. Pascual-Leone A, Freitas C, Oberman L, Horvath JC, Halko M, Eldaief M, Bashir S, Vernet M, Shafi M, Westover B, Vahabzadeh-Hagh AM, Rotenberg A (2011) Characterizing brain cortical plasticity and network dynamics across the age-span in health and disease with TMS-EEG and TMS-fMRI. Brain Topogr 24:302–315PubMedCentralCrossRefPubMedGoogle Scholar
  57. Patel M, Bailey RK, Jabeen S, Ali S, Barker NC, Osiezagha K (2012) Postpartum depression: a review. J Health Care Poor Underserved 23:534–542CrossRefPubMedGoogle Scholar
  58. Penza KM, Heim C, Nemeroff CB (2003) Neurobiological effects of childhood abuse: implications for the pathophysiology of depression and anxiety. Arch Womens Ment Health 6:15–22CrossRefPubMedGoogle Scholar
  59. Plaza A, Garcia-Esteve L, Torres A, Ascaso C, Gelabert E, Luisa Imaz M, Navarro P, Valdes M, Martin-Santos R (2012) Childhood physical abuse as a common risk factor for depression and thyroid dysfunction in the earlier postpartum. Psychiatry Res 200:329–335CrossRefPubMedGoogle Scholar
  60. Qiu C, Sanchez SE, Lam N, Garcia P, Williams MA (2007) Associations of depression and depressive symptoms with preeclampsia: results from a Peruvian case-control study. BMC Womens Health 7:15PubMedCentralCrossRefPubMedGoogle Scholar
  61. Rao U, Chen LA, Bidesi AS, Shad MU, Thomas MA, Hammen CL (2010) Hippocampal changes associated with early-life adversity and vulnerability to depression. Biol Psychiatry 67:357–364PubMedCentralCrossRefPubMedGoogle Scholar
  62. Roberts R, O’Connor T, Dunn J, Golding J, ALSPAC Study Team (2004) The effects of child sexual abuse in later family life; mental health, parenting and adjustment of offspring. Child Abuse Negl 28:525–545CrossRefPubMedGoogle Scholar
  63. Robertson-Blackmore E, Putnam FW, Rubinow DR, Matthieu M, Hunn JE, Putnam KT, Moynihan JA, O’Connor TG (2013) Antecedent trauma exposure and risk of depression in the perinatal period. J Clin Psychiatry 74:e942–e948CrossRefPubMedGoogle Scholar
  64. Sanchez SE, Puente GC, Atencio G, Qiu C, Yanez D, Gelaye B, Williams MA (2013) Risk of spontaneous preterm birth in relation to maternal depressive, anxiety, and stress symptoms. J Reprod Med 58:25–33PubMedCentralPubMedGoogle Scholar
  65. Segerstrom SC, Miller GE (2006) Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull 130:601–630CrossRefGoogle Scholar
  66. Seng JS, Low LK, Sperlich M, Ronis DL, Liberzon I (2011) Post-traumatic stress disorder, child abuse history, birthweight and gestational age: a prospective cohort study. Br J Obset Gynaec 118:1329–1339CrossRefGoogle Scholar
  67. Skalkidou A, Hellgren C, Comasco E, Sylven S, Sundstrom Poromaa I (2012) Biological aspects of postpartum depression. Womens Health (London Engl) 8:659–672CrossRefGoogle Scholar
  68. Slopen N, Kubzansky LD, McLaughlin KA, Koenen KC (2012) Childhood adversity and inflammatory processes in youth: a prospective study. Psychoneuroendocrinology 38:188–200PubMedCentralCrossRefPubMedGoogle Scholar
  69. Sockol LE, Epperson CN, Barber JP (2013) Preventing postpartum depression: a meta-analytic review. Clin Psychol Rev 33:1205–1217PubMedCentralCrossRefPubMedGoogle Scholar
  70. Stoltenborgh M, van Ijzendoorn MH, Euser EM, Bakermans-Kranenburg MJ (2011) A global perspective on child sexual abuse: meta-analysis of prevalence around the world. Child Maltreat 16:79–101CrossRefPubMedGoogle Scholar
  71. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012CrossRefPubMedGoogle Scholar
  72. Varkukla M, Viguera AC, Gonsalves L (2009) Depression and pregnancy. Compr Ther 35:44–49PubMedGoogle Scholar
  73. Verbeek T, Bockting CL, van Pampus MG, Ormel J, Meijer JL, Hartman CA, Burger H (2012) Postpartum depression predicts offspring mental health problems in adolescence independently of parental lifetime psychopathology. J Affect Disord 136:948–954CrossRefPubMedGoogle Scholar
  74. Verhoeven JE, Revesz D, Epel ES, Lin J, Wolkowitz OM, Penninx BW (2014) Major depressive disorder and accelerated cellular aging: results from a large psychiatric cohort study. Mol Psychiatry 19:895–901CrossRefPubMedGoogle Scholar
  75. Walker MJ, Davis C, Al-Sahab B, Tamim H (2013) Reported maternal postpartum depression and risk of childhood psychopathology. Matern Child Health J 17:907–917CrossRefPubMedGoogle Scholar
  76. Waymire V (1997) A triggering time. Childbirth may recall sexual abuse memories. AWHONN Lifelines 1:47–50CrossRefPubMedGoogle Scholar
  77. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (1999) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa (ON): Ottawa Health Research Institute. Accessed November 6, 2014.
  78. World Health Organization (2003) Guidelines for medico-legal care for victims of sexual violence. Geneva, Switzerland: 1-144Google Scholar
  79. World Health Organization (2012) Depression: fact sheet. Accessed November 5, 2014.
  80. Yehuda R, Flory JD, Pratchett LC, Buxbaum J, Ising M, Holsboer F (2010) Putative biological mechanisms for the association between early life adversity and the subsequent development of PTSD. Psychopharmacol (Berlin) 212:405–417CrossRefGoogle Scholar
  81. Yim IS, Glynn LM, Dunkel-Schetter C, Hobel CJ, Chicz-DeMet A, Sandman CA (2009) Risk of postpartum depressive symptoms with elevated corticotropin-releasing hormone in human pregnancy. Arch Gen Psychiatry 66:162–169PubMedCentralCrossRefPubMedGoogle Scholar
  82. Yonkers KA, Smith MV, Forray A, Epperson CN, Costello D, Lin H, Belanger K (2014) Pregnant women with posttraumatic stress disorder and risk of preterm birth. JAMA Psychiatry 71:897–904PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • Adaeze C. Wosu
    • 1
  • Bizu Gelaye
    • 1
    Email author
  • Michelle A. Williams
    • 1
  1. 1.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA

Personalised recommendations