Exploring psychological abuse in childhood: II. Association with other abuse and adult clinical depression.

A new retrospective interview assessment of childhood psychological abuse, an extension to the Childhood Experience of Care and Abuse (CECA) instrument, is described in a companion article (Moran, Bifulco, Ball, Jacobs, & Benaim, 2002). The purpose of the present article is to examine the relationship of childhood psychological abuse to other adverse childhood experiences and to major depression and suicidal behavior in adult life. Childhood experience and lifetime disorder were assessed retrospectively in a high-risk, community series of London women (n = 204). Psychological abuse from parents was examined in relation to seven other parental behaviors (neglect, antipathy, role reversal, discipline, supervision, physical abuse, and sexual abuse). Psychological abuse was significantly related to all seven behaviors. The highest associations found were to antipathy (gamma = .76), neglect (.73), and sexual abuse (.72). Factor analysis showed the existence of two factors reflecting care and control, with psychological abuse associated with both factors. Childhood psychological abuse was highly related to chronic or recurrent adult depression, with a "dose-response" evident for severity of abuse. The rates ranged from 83% for "marked" to 55% for "mild" abuse and 37% for "little/no" psychological abuse (p < .002). Psychological abuse was also related to lifetime suicidal behavior but here any level of abuse from marked to mild had similar rates (36% overall vs. 18% with no psychological abuse, p < .04). There was no evidence of specificity of childhood experience to adult depression; nearly all types of childhood adversity examined were significantly related. An analysis using an index of multiple abuse, including psychological abuse, showed a clear dose-response relationship to disorder. Somewhat fewer forms of maltreatment were related to suicidal behavior, but again multiples showed a clear dose-response effect.