The ripple effects of childhood abuse extend well beyond the immediate time surrounding the abuse and can continue to cause significant disruption throughout a person’s life, even if on the surface things seem calm.
Studies show that so-called adverse childhood experiences — stressful or traumatic events including physical, emotional or sexual abuse and physical or emotional neglect — can raise the risk of everything from substance abuse and mental health issues to sleep disruption, obesity, heart attack and diabetes and even shortened lifespan. Research has found childhood abuse is associated with depression not only in kids, adolescents and young adults, but in later life as well.
“Time just doesn’t magically heal,” says Adria Pearson-Mauro, an assistant professor of family medical and psychiatry at the University of Colorado School of Medicine, and a clinical psychologist at CU’s Helen and Arthur E. Johnson Depression Center in Aurora. She says these kinds of threats and the impact they can have on neurodevelopment of someone who is abused as a child physically or sexually always matter. “It doesn’t become less important with age,” Pearson-Mauro says.
At a particularly vulnerable period in a person’s life when one’s brain and very sense of self are still developing, abuse can affect a child on a deeply personal and even biological level. That’s not to say that everyone who is abused as a child will necessarily go on to experience depression or that everyone who experiences depression endured adverse childhood experiences, such as abuse, neglect or other stressors like living with an alcoholic parent. But, experts say, those so-called ACEs certainly increase one’s risk of suffering from depression.
[See: Coping With Depression at Work.]
Many people who faced early life adversity don’t experience mental health issues later. “Some people may have more resilience, some have less,” says Dr. Robert Shulman, associate chair of psychiatry and director of clinical services at Rush University Medical Center in Chicago. The reasons why some end up suffering from depression while others don’t vary — and aren’t fully known; but they range from biological, or epigenetic predisposition — influencing how genes are expressed during a person’s life — that may make them more vulnerable to mental health concerns, to so-called psychosocial risk factors, such as having a limited social network.
Recent research set out to better understand the psychosocial factors, or mediators, that may contribute to depression later in life in people who experienced childhood abuse. The study published last month in the International Journal of Geriatric Psychiatry found an association between childhood abuse and depression in older adults and additionally suggests that a smaller social network and feelings of loneliness may help explain the link between childhood abuse and early-onset depression in older adults, or depression beginning before age 60. “Our findings suggest that smaller social networks and feelings of loneliness are important factors in late-life depression in older adults with a history of childhood abuse and with an early-onset depression,” the researchers wrote. The study did not find any psychosocial mediators that might help explain the association between childhood abuse and higher rates of late-onset depression, or that beginning in people 60 and older.
“We concluded that it is important to give more attention to childhood abuse in depressed older adults, not only early in life, but also later in life,” lead study author Ilse Wielaard, a PhD student working at the psychiatric department at the VU University Medical Center in Amsterdam, Netherlands, wrote in an email. “It is somewhat more common to develop a depression earlier in life in [the] case of childhood abuse. However, there is still a strong and robust association with middle-age (40-60 years) and late-onset (60 years and older) depression,” she adds.
More study is needed, and the researchers as well as other experts note that various factors that weren’t measured in the study, like chronic disease, can contribute to depression. Generally speaking, the risk for depression is increased in older adults — for reasons ranging from brain changes to higher rates of isolation to more chronic conditions. But mental health experts reiterate that the effects of childhood abuse are wide-sweeping, including often making it harder to form and preserve close relationships, or maintain a robust social network years later. By the same token, the depression a person may experience later in life could have to do with other factors unrelated to childhood abuse.
[See: 4 Subtle Signs of Depression in Men.]
Clinicians say it’s important a history of childhood abuse is at least discussed to determine if it is a factor, and that health providers should ask about past trauma, including abuse, given the far-reaching effects it can have and since patients might not mention it unless their health provider inquires about the subject. “People might not volunteer that information [for] various different reasons. They might not think it matters. It was a long time ago,” Pearson-Mauro says. There are generational differences when it comes to transparency as well; some older people may be especially reluctant to broach a conversation about abuse they experienced as a child. With the #MeToo movement, “just now people are starting to talk more openly about having been a victim of sexual abuse,” Pearson-Mauro says.
Many people have never talked about or had a chance to emotionally process abuse that happened decades ago, or had those feelings validated by another person, whether a family member, friend or therapist. “An unprocessed event can lend itself to thoughts that are inaccurate about that person’s self-worth, about the world around them, about their personal safety, and about other people and their trustworthiness,” Pearson-Mauro says. “And that impacts mood of course.”
While there’s no specific therapeutic prescription for a person with depression who experienced childhood abuse, mental health experts say seeking to discern if there’s a link between the two, and particularly if so, talking more about that past abuse as part of treatment is important. If, for example, a person is advocating for an older parent who has depression and a history of childhood abuse, Shulman recommends going beyond simply taking that parent to the primary care doctor to get a prescription for an antidepressant. “Having the opportunity to get the parent in to see a counselor is very important,” he says. “I have to tell you that all the counselors — the psychologists and social workers I’ve known that work with older adults — are incredibly kind people, who are so willing to listen and to be supportive and caring.”
In addition to getting depression under control — such as with medication and therapy — dealing with the trauma can help improve outcomes, experts say.
“If an older adult has childhood abuse experiences, I think it is important to create a safe context in which the patient can be open and honest about it,” Wielaard says. If it’s too difficult to talk about, that might mean initially expressing oneself in other ways, like writing about the abuse. “When appropriate, the focus in therapy could be on childhood trauma,” she adds.
“If it is relevant, I would look at the necessity of doing some intervention — psychotherapy intervention — to address post-traumatic stress symptomology as well as depression. Because you’re kind of treating both in a way,” Pearson-Mauro says. “You don’t want to like necessarily delve right into the trauma and do intensive trauma treatment with someone who’s quite depressed, because they might not have the coping skills to handle revisiting those memories right away,” she says. The point is to integrate addressing the trauma to the extent it’s related to the depression, and in due time, as makes sense for the patient, experts say.
[See: How to Find the Best Mental Health Professional for You.]
Much better to do that than trying to bury it, until it resurfaces again. For an older person who has a history of childhood abuse, it may have been a long time since the abuse took place, but experts emphasize that doesn’t mean it’s forgotten — or that it doesn’t still have the potential to hurt that person.
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Could a History of Childhood Abuse Be Contributing to Your Depression? originally appeared on usnews.com
