Sexual abuse is a widespread problem in societies across the world. In Canada, 1 in 3 women and 1 in 11 men will be sexually abused at some point over their lifetime. We’ve talked about many of the common reactions to sexual assaults, but these don’t cover all possible reactions. Moreover, people’s responses to a traumatic event might change over time. So, when it comes to more longstanding challenges, one question remains. Can sexual abuse cause depression?
Some definitions
In the past, we have talked about the different kinds of sexual abuse that can happen to someone. But, here we can work with a broad definition of sexual abuse. According to the American Psychological Association, this encompasses any undesired sexual activity where the perpetrator uses force, threats, or takes advantage of victims unable to give consent. This framework is helpful, but it is important to recognize that there are many ways this can manifest. This includes indecent exposure, unwanted touching, and forced sexual intercourse. Some people may even experience sexual abuse without knowing that it happened.
Depression, on the other hand, is a medical diagnosis. It is more than just feeling sad. In fact, there is a list of symptoms required to meet the criteria for a depressive episode or for a depressive disorder. These mainly come from a book called the Diagnostic and Statistical Manual for Mental Disorders (DSM). On top of a depressed mood, this includes things like:
- a loss of pleasure,
- significant changes to weight and/or appetite,
- slowing down physically and mentally,
- having no energy throughout the day,
- feeling worthless or guilty without good reason,
- impacts to thinking and concentration,
- and recurring thoughts of death and/or suicide
Not all of these have to be met for someone to be clinically depressed. However, the more that are present, the more severe the depression is. Someone may just have one episode of depression through their whole life, or it may be something that comes back from time to time. Either way, there are ways to cope with depression, including using medications and psychotherapies. There are also ways to help other people who are living with depression.
So, can sexual abuse cause depression?
The short answer is probably yes. The longer answer is that there is a correlation, but to know whether it is a direct causation is hard because not everyone who gets sexually abused becomes depressed. In mental health, there often is a combination of factors that come together to make someone vulnerable to becoming unwell. This is known as the stress-vulnerability model. Essentially, every person has a mixture of genetic vulnerabilities or strengths that interact with risk or protective factors in their environment. So, the end result is different for each person because of their unique position in life.
It is clear that there is a link between childhood sexual abuse and depression. For adult survivors, the question can sexual assault cause depression is less clearcut. The prevalence rate for depression among adult survivors of sexual abuse is between 13-51%. This varies when looking at specific populations. One meta-analysis (when a bunch a scientific studies are examined together) found that, for an experience of sexual abuse at any point during someone’s lifetime, the prevalence of depression is around 39%.
What are the odds?
One way of measuring the likelihood that something occurs for a reason other than chance is by looking at odds ratios. These are the proportions of people in one group who experience something when compared to another group. An odds ratio of 1.0 is an equal occurrence among the 2 groups. However, odds ratios of 0.5 or 2.0 mean that something was twice as likely to happen in one of the groups than the other.
The same meta-analysis from above looked at lifetime sexual abuse and adolescent/adult sexual abuse compared with populations who hadn’t been sexually abused. The odds ratios for these 2 groups were 3.87 and 3.25 respectively. While they are similar, they show a slightly less likelihood of developing depression among people who aren’t sexually abused as children. Keep in mind that the lifetime group includes sexual abuse from any point in someone’s life, so the odds ratio for childhood sexual abuse is probably even higher. With that said, the connection between sexual assault and depression is considerable regardless of the age the abuse happens.
Conclusion
When we ask “can sexual abuse cause depression,” it raises a complex issue. Many people who experience sexual abuse do also experience depression. Especially in the time right afterwards. But does this mean that they are stuck with these emotions forever? Not necessarily. Post traumatic growth after sexual abuse provides a hopeful outlook for someone who is in the depths of their emotions.
While depression is a completely understandable and normal reaction to being sexually assaulted, asking can sexual assault cause depression misses a big piece of nuance with the topic. Yes, sexual violence is a risk factor in the stress-vulnerability model, but being aware of the protective factors (or buffers) against depression are important parts of healing.
Maintaining hope that help is out there can make a big difference in someone’s healing journey. To use the academic language of the meta-analysis looking at sexual abuse and depression: “trauma help-seeking samples had significantly smaller [odds ratios for depression] than community samples”. This means that, compared to the general population, those who look for support after sexual abuse are much less likely to suffer from depression afterwards. So, if you or someone you know has been sexually abused, please reach out for help. We wrote a whole handbook about your rights after being sexually abused. Additionally, Canada’s Victim’s Services Directory can help find a resource near you.
