Background. This study was designed to determine lifetime prevalence of psychiatric disorders among twins who reported childhood sexual abuse (CSA), and to compare these rates with those among non-abused co-twins. The contribution of familial and individual-specific factors to reported sexual abuse was also examined.

Method. Information about lifetime psychopathology and substance use was obtained by structured telephone interviews with 5995 Australian twins. Twins who reported a history of childhood sexual abuse (CSA) were contrasted on lifetime psychopathology with subjects without such a history; in addition, comparisons were made between same-sex twin pairs discordant for CSA.

Results. A history of CSA was reported by 5·9% of the women and 2·5% of the men. In the sample as a whole, those reporting CSA were more likely to receive lifetime diagnoses of major depression, conduct disorder, panic disorder and alcoholism, and were more likely to report suicidal ideation and a history of suicide attempt. Abused women, but not men, were also more likely to report social phobia. When comparisons were restricted to non-abused co-twins, no differences in psychopathology were seen. However, rates of major depression, conduct disorder and suicidal ideation were higher if both co-twins were abused than if the respondent alone reported CSA. Model-fitting indicated that shared environmental factors influenced risk for reported CSA in women, but not in men.

Conclusion. The association between CSA and psychopathology arises at least in part through the influence of shared familial factors on both risk of victimization and risk of psychopathology.

Background. Data on the course of anxiety in late life are scarce. The present study sets out to investigate the course of anxiety, as measured by the HADS-A (Zigmond & Snaith, 1983) in community dwelling older persons, and to evaluate predictive factors for change over 3 years in anxiety symptoms following the vulnerability/stress model.

Method. Based on the first anxiety assessment, two cohorts were formed: subjects with and subjects without anxiety symptoms. In the non-anxious cohort (N = 1602) we studied risk factors for the development of anxiety symptoms; in the anxious cohort (N = 563) the same factors were evaluated on their predictive value for restitution of symptoms. Risk factors included vulnerability factors (demographics, health status, personality characteristics and social resources) and stressors (life events occurring in between both anxiety assessments). Logistic regression models estimated the effects of vulnerability factors, stress and their interaction on the likelihood of becoming anxious and chronicity of anxiety symptoms.

Results. It was indicated that the best predictors for becoming anxious were being female, high neuroticism, hearing/eyesight problems and life-events. Female sex and neuroticism also increased the likelihood of chronicity of anxiety symptoms in older adults, but life events were not related to chronicity. The main stressful event in late life associated with anxiety was death of one's partner. Vulnerability factors and stress added on to each other rather than their interaction being associated with development or chronicity of anxiety.

Conclusion. The vulnerability/stress model offers a useful framework for organizing risk factors for development and chronicity of anxiety symptoms in older persons, but no support was attained for the hypothesis that vulnerability and stress amplify each others effects. Finally, the results indicate to whom preventive efforts should be directed: persons high in neuroticism, women, and those who experience distressing life events.

Background. Although parenting has long been considered an important risk factor for subsequent psychopathology, most investigations of this question have studied a single informant, clinical populations, one or a few disorders and did not consider relevant covariates.

Methods. Three dimensions of parenting (coldness, protectiveness and authoritarianism) were measured by combining the retrospective reports from adult female twins, their co-twins, and their mothers and fathers. We assessed by personal interview, lifetime history in the twins of eight common psychiatric and substance abuse disorders and a range of predictors of parenting. Analyses were performed using logistic regression.

Results. Examined individually, high levels of coldness and authoritarianism were modestly but significantly associated with increased risk for nearly all disorders, while the impact of protectiveness was more variable. These associations declined modestly when putative predictors of parenting were added as covariates. Maternal and paternal parenting were equally associated with outcomes in adult daughters. When coldness, protectiveness and authoritarianism were examined together, nearly all significant associations were seen solely with coldness. Few significant interactions were found between maternal and paternal parenting or between coldness, protectiveness and authoritarianism. The shared experience of these three dimensions of parenting predicts a quite small correlation in liability to these disorders in dizygotic twin pairs (e.g. r < 0·04).

Conclusion. In women, parenting behaviour, especially levels of coldness, is probably causally related to risk for a broad range of adult psychiatric disorders. The impact of parenting on substance use disorders may be largely mediated through their co-morbidity with major depression, phobias and generalized anxiety disorder. In general population samples, the association of poor parenting with psychiatric illness is modest, largely non-specific and explains little of the observed aggregation of these disorders in families.

Background. Although the traditional view of bipolar affective disorder is that the majority of patients have full remission between episodes, recent evidence suggests that residual cognitive deficits are present. The aim of this study was to determine whether memory and executive deficits were present in a well-defined clinically remitted group of patients.

Methods. This was a case–control study of bipolar patients in remission (N = 18). Subjects had to fulfil stringent clinical criteria for inclusion into the study and had to have been in remission for at least 4 months. Subjects also had no history of substance dependence. The cognitive battery examined memory and executive function.

Results. Patients in excellent clinical remission and who reported good social adaptation showed impairment on tests of visuospatial recognition memory. Accuracy on four tests of executive function was not impaired in patients in remission compared with controls, although response latency on these executive tests was still impaired.

Conclusions. As our group and others have shown, patients with mania and unipolar depression show generalized impairment on tests of memory and executive function. In comparison, this study has demonstrated that patients in remission show a relatively specific impairment in memory with recovery of accuracy measures on executive function task. The increased response latency on the executive tasks suggests a possible small residual impairment. These findings suggest that in neuroanatomical terms, more posterior cortical function (temporal lobe) has not improved but there is at least some recovery of frontal lobe function in remission.

Background. Patients with obsessive–compulsive disorder (OCD) have symptoms that pre-dominantly concern washing (washers) or checking (checkers), or both. Functional neuroimaging has been used to identify the neural correlates of the urge to ritualize but has not distinguished between washing and checking symptoms in OCD. We used functional magnetic resonance imaging to compare the neural response to emotive pictures in washers and checkers.

Methods. In one of two 5-minute experiments, washers (N = 7), checkers (N = 7) and age-matched normal controls (N = 14) were scanned while viewing alternating blocks of normally disgusting (rated as disgusting by all subjects) and neutral pictures. In the other experiment, all patients and a normal subgroup (N = 8) viewed alternating blocks of washer-relevant (rated as more disgusting by washers than normal controls or checkers) and neutral pictures.

Results. In all subjects, normally disgusting pictures activated visual regions implicated in perception of aversive stimuli and the insula, important in disgust perception. Only in washers were similar regions activated by washer-relevant pictures. In checkers, these pictures activated fronto-striatal regions associated with the urge to ritualize in OCD. Normal controls were more similar in neural response to checkers than washers to these pictures. Both normal controls and checkers had frontal regions activated significantly more by washer-relevant than normally disgusting pictures, and had these regions activated significantly more than washers by washer-relevant pictures.

Conclusions. We demonstrate a differential neural response to washer-relevant disgust in washers and checkers: only washers demonstrate a neural response to washer-relevant disgust associated with emotion perception rather than attention to non-emotive visual detail.

Background. The aims of this study were to use longitudinal report data on physical and sexual abuse to examine the stability and consistency of abuse reports.

Methods. The study was based on the birth cohort of young people studied in the Christchurch Health and Development Study. At ages 18 and 21 years, these young people were questioned about their childhood exposure to physical punishment and sexual abuse. Concurrent with these assessments, sample members were also assessed on measures of psychiatric disorder and suicidal behaviour.

Results. Reports of childhood sexual abuse and physical punishment were relatively unstable and the values of kappa for test–retests of abuse reporting were in the region of 0·45. Inconsistencies in reporting were unrelated to the subject's psychiatric state. Latent class analyses suggested that: (a) those not abused did not falsely report being abused; and (b) those who were abused provided unreliable reports in which the probability of a false negative response was in the region of 50%. Different approaches to classifying subjects as abused led to wide variations in the estimated prevalence of abuse but estimates of the relative risk of psychiatric adjustment problems conditional on abuse exposure remained relatively stable.

Conclusions. There was substantial unreliability in the reporting of child abuse. This unreliability arose because those who were subject to abuse often provided false negative reports. The consequences of errors in reports appear to be: (a) that estimates of abuse prevalence based on a single report are likely to seriously underestimate the true prevalence of abuse; while (b) estimates of the relative risk of psychiatric adjustment problems conditional on abuse appear to be robust to the effects of reporting errors.

Background. Childhood antecedents are often put forward as being of possible aetiological significance for both anorexia nervosa and bulimia nervosa.

Method. Comparisons were made of groups of women with eating disorders with groups of women with major depression or without current psychiatric disorder, using the Childhood Experience of Care and Abuse interview (CECA).

Results. Women with bulimia nervosa (or mixed bulimia and anorexia nervosa) tended to report more troubled childhood experiences than did women from the non-morbid comparison group. In this respect, they resembled those with major depression. In contrast, those with anorexia nervosa resembled the non-morbid women rather than the other psychiatric groups.

Conclusions. Adversity in childhood as measured by the CECA may play a part in the causation of bulimia nervosa but not of anorexia nervosa. It remains possible that more specific or subtle family influences may be relevant.

Background. As previous studies with homosexual males have revealed a later birth order, more older brothers and more brothers than sisters, this research was extended to a large series of transsexual males and females, some of whom are homosexual.

Methods. The male sample comprised 442 male-to-female transsexuals, subdivided by sexual partner preference: 106 homosexual, 135 heterosexual, 155 bisexual and 46 asexual. One hundred female-to-male transsexuals were also studied: 75 homosexual, 16 bisexual, seven heterosexual and five asexual. Birth order was computed by both Slater's Index and Berglin's Index.

Results. Homosexual male-to-female transsexuals have a later than expected birth order and more older brothers than other subgroups of male-to-female transsexuals. Each older brother increases the odds that a male transsexual is homosexual by 40%.

Conclusions. Hypotheses explaining the extension of prior findings to this large sample of transsexual males include a progressive maternal immunization to the male foetus either through the H-Y antigen or protein-bound testosterone or alterations in foetal androgen levels in successive pregnancies, all modifying male psychosexual development. Data on the sexual orientation of younger brothers of homosexual male transsexuals in this study are not consistent with the progressive immunization hypothesis.

Background. We examined the relationship between childhood sexual abuse (CSA), and interviewees' recollections of pathogenic parenting, testing for possible retrospective biases in the recollections of those who have experienced CSA.

Methods. Information about CSA, parental divorce and interviewees' recollections of parental rejection, parental overprotection and perceived autonomy (as assessed through a shortened version of the Parental Bonding Instrument) was obtained through telephone interviews with 3626 Australian twins who had also returned self-report questionnaires several years earlier. Recollections of parental behaviours were compared for individuals from pairs in which neither twin, at least one twin, or both twins reported CSA.

Results. Significant associations were noted between CSA and paternal alcoholism and between CSA and recollections of parental rejection. For women, individuals from CSA-discordant pairs reported levels of parental rejection that were significantly higher than those obtained from CSA-negative pairs. The levels of parental rejection observed for twins from CSA-discordant pairs did not differ significantly from those obtained from CSA-concordant pairs, regardless of respondent's abuse status. For men from CSA-discordant pairs, respondents reporting CSA displayed a tendency to report higher levels of parental rejection than did respondents not reporting CSA. Other measures of parenting behaviour (perceived autonomy and parental overprotection) failed to show a clear relationship with CSA.

Conclusions. The relationship between CSA and respondents' recollections of parental rejection is not due solely to retrospective bias on the part of abused individuals and, consistent with other studies, may reflect a pathological family environment with serious consequences for all siblings.

Background. Based on the developing clinical and legal literature, and using the framework adopted in draft legislation, capacity to make a valid decision about a clinically required blood test was investigated in three groups of people with a ‘mental disability’ (i.e. mental illness (chronic schizophrenia), ‘learning disability’ (‘mental retardation’, or intellectual or developmental disability), or, dementia) and a fourth, comparison group.

Methods. The three ‘mental disability’ groups (N = 20 in the ‘learning disability’ group, N = 21 in each of the other two groups) were recruited through the relevant local clinical services; and through a phlebotomy clinic for the ‘general population’ comparison group (N = 20). The decision-making task was progressively simplified by presenting the relevant information as separate elements and modifying the assessment of capacity so that responding became gradually less dependent on expressive verbal ability.

Results. Compared with the ‘general population’ group, capacity to make the particular decision was significantly more impaired in the ‘learning disability’ and ‘dementia’ groups. Importantly, however, it was not more impaired among the ‘mental illness’ group. All the groups benefited as the decision-making task was simplified, but at different stages. In each of the ‘mental disability’ groups, one participant benefited only when responding did not require any expensive verbal ability.

Conclusions. Consistent with current views, capacity reflected an interaction between the decision-maker and the demands of the decision-making task. The findings have implications for the way in which decisions about health care interventions are sought from people with a ‘mental disability’. The methodology may be extended to assess capacity to make other legally-significant decisions.

Background. People with intellectual disabilities who have been victims or other witnesses of crime have had limited access to the criminal justice system, often on the basis of assumptions about their incapacity to be interviewed by the police and to give evidence in court. The aim of this study was to assess their capacity to be witnesses in court.

Methods. Forty-nine men and women with intellectual disabilities, all of whom were potential witnesses of ill-treatment, were assessed in order to provide advice, initially to the police, about their capacity to be interviewed for judicial purposes. The assessments included evaluations of each person's intellectual ability, memory, acquiescence, suggestibility, and their ability to explain concepts relating to the oath.

Results. Only 37 (76%) were able to complete the assessments. Most of those with a Full Scale IQ score of [ges ] 60 had a basic understanding of the oath, compared with only a third of those with IQ scores between 50 and 59, and none of those with IQ scores < 50. Nevertheless, some of the people who were unable to demonstrate an understanding of the oath did understand the words ‘truth’ and ‘lie’, especially when asked about these concepts in relation to concrete examples.

Conclusions. While intellectual ability appears to be the best overall predictor of the capacity of people with intellectual disabilities to act as witnesses, confining witnesses to those who could explain the meaning of the oath would mean that a number of persons who might be interviewed by the police and subsequently appear in court could be excluded from the judicial process.

Background. The importance of genetic factors in the aetiology of manic-depressive illness (MDI) has been repeatedly confirmed and indicators of vulnerability to the illness in families with affective disorders are needed. Abnormal event-related potentials (ERP) may be markers of genetic vulnerability to mental illness. Long latency and low amplitude of P300 have consistently been reported in schizophrenic patients and their relatives. A few studies have also shown P300 deficits in MDI patients, but no ERP study has been performed on their relatives.

Methods. ERPs were recorded during an auditory oddball task in 19 relatives belonging to families with two or more bipolar patients and in controls with no familial or personal history of affective disorders. The relatives were selected as having no affective disorders on a lifetime basis, but eight had an anxiety disorder.

Results. In all relatives, a lower P300 amplitude and a longer P300 latency was found, with much longer reaction time and post-N200 duration till button-press than controls. A lack of P300 amplitude dominance in the right hemisphere was also found in relatives in comparison with controls. There also appeared to be a frontal predominance of ERP abnormalities in relatives.

Conclusion. We report the first evidence of deficits in reaction time and in P300 amplitude and latency, and a lack of P300 right-sided dominance, in relatives of manic-depressive patients. This pattern may constitute an endophenotypic marker of manic-depressive disorder.

Background. Somatoform disorders such as neurasthenia and chronic fatigue syndrome are characterized by a combination of prolonged mental and physical fatigue. This study aimed to investigate the heritability of somatic distress and determine whether this dimension is aetiologically distinct from measures of depression and anxiety.

Method. Measures of anxiety, depression, phobic anxiety, somatic distress and sleep difficulty were administered in a self-report questionnaire to a community-based sample of 3469 Australian twin individuals aged 18 to 28 years. Factor analysis using a Promax rotation, produced four factors: depression, phobic anxiety, somatic distress and sleep disturbance. Multivariate and univariate genetic analyses of the raw categorical data scores for depression, phobic anxiety and depression were then analysed in Mx1.47.

Results. Univariate genetic analysis revealed that an additive genetic and non-shared environmental (AE) model best explained individual differences in depression and phobic anxiety scores, for male and female twins alike, but could not resolve whether additive genes or shared environment were responsible for significant familial aggregation in somatic distress. However, multivariate genetic analysis showed that an additive genetic and non-shared environment (AE) model best explained the covariation between the three factors. Furthermore, 33% of the genetic variance in somatic distress was due to specific gene action unrelated to depression or phobic anxiety. In addition, 74% of the individual environmental influence on somatic distress was also unrelated to depression or phobic anxiety.

Conclusion. These results support previous findings that somatic symptoms are relatively aetiologically distinct both genetically and environmentally from symptoms of anxiety and depression.

Background. This report attempted to replicate and extend prior work examining social phobia (SP), co-morbid psychiatric illnesses, and the risk of suicidal ideation and suicide attempts incurred by their adolescent sufferers.

Methods. SP, alcohol dependence (ALD) and major depressive disorder (MDD) diagnoses, and suicide-related symptoms, were assessed in a population-based adolescent female twin sample. The differentiation of risks as a function of co-morbidity was explored. A trivariate model was fitted to estimate sharing of genetic and environmental vulnerability between SP and co-morbid disorders.

Results. The lifetime prevalence of SP was 16·3%. Significant risk for co-morbid MDD (OR = 3·2) and ALD (OR = 2·1) was observed. Strong evidence for shared genetic vulnerability between SP and MDD (respective heritabilities 28%, 45%; genetic r = 1·0) was observed with moderate support noted for similar sharing between SP and ALD (genetic r = 0·52, heritability for ALD 63%). SP with co-morbid MDD was associated with elevated risk for ALD and for suicide-related symptoms.

Conclusions. SP is a common illness often followed by co-morbid MDD and ALD. SP with co-morbid MDD predicts a substantially elevated risk of ALD and suicide-related symptoms, stressing the need for early SP detection.

Background. Studies of family relationships in anorexia nervosa have produced conflicting results. Some authors claim that family factors are related to short-term outcomes.

Methods. Perceived rearing practices, as measured by the EMBU (Egna Minnen Betraffande Uppfostran: ‘My memories of Upbringing’) were examined in a sample (N = 158) of adolescents with anorexia nervosa and compared with the perceptions of adolescents (N = 159) from the general population. A further comparison was made between the groups of patients with good and bad short-term outcomes. Logistic regression analysis was performed to evaluate the predictive value of different variables on short-term outcome.

Results. Overall, small differences were observed in the perceptions of rearing practices as expressed by the controls and the anorexic patients. Patients with bad short-term outcome perceived more rejection and control–overprotection from both parents than those with good outcome. In the logistic regression analysis only Rejection from father and the EAT (Eating Attitudes Test) total score gave independent prediction of treatment response.

Conclusions. Taken as a whole, these results do not support the idea of altered rearing practices in anorexic patients, at least in young patients with a short evolution of the disease. Perceived rearing practices, especially ‘rejection’, appear to have an appreciable effect on the short-term outcome.

Background. Previous studies of parental discipline have identified little influence of heritability on parental control, and some influence of gene–environment correlations, shared environment and child temperament.

Method. Using interview data from 2003 female twins from a population-based twin registry and 1472 of their parents, we examined reports of parental discipline from four perspectives: (1) father and mother reporting separately on the type of discipline they provided for their offspring; (2) each twin reporting on the type of discipline they received from their parents; (3) each parent reporting on the discipline provided by their spouse; and, (4) each twin reporting on the discipline they provided for their own offspring. Using factor analysis and univariate structural equation modelling, we examined the structure of parental discipline, and the genetic and environmental influences thereon.

Results. The seven discipline items yielded two factors, physical discipline and limit setting, which were moderately positively correlated. Parents perceived discipline as largely a common environmental experience for the twins, whereas the twins indicated that discipline was influenced by unique environmental factors and the genotype of the child. Twins as parents indicated no influence of shared environment on discipline, with the majority of influence accounted for by non- shared environment and parental genotype.

Conclusions. Parents recall providing similar discipline to their children, whereas children emphasize the differences in parental discipline. Sources of individual variation in parental discipline vary according to which family member report is examined. In total, parental discipline is partially influenced by the genotype of both the parent and child, and by environmental factors shared by the twins and unique to the individual.

Background. Patients with schizophrenia have a winter–spring excess of births compared with the general population, the cause of which is unresolved. Fluctuations in the magnitude of the seasonal variation may provide clues to its aetiology.

Methods. All Finnish patients with schizophrenia born between 1950 and 1969 (N = 15892) were identified from two nationwide health-care registers. Their background demographic information was obtained from the Population Register Centre, which also provided monthly numbers of births in each municipality of Finland as multidimensional tables, with sex and year, month and place of birth as marginals. The incidence of schizophrenia was modelled using Poisson regression analysis, with sex, onset age, birth cohort, place of birth (urban/rural), trend and seasonal variation as explanatory variables. We also constructed a monthly time series and decomposed it into three components – seasonal, trend and remainder.

Results. Seasonal variation of births among patients born in the 1950s, especially between 1955 and 1959, was marked, but decreased among patients born in the 1960s. No interaction between place of birth or sex and seasonal variation was observed. The incidence was higher among the rural-born than the urban-born, but declined more slowly among the urban-born than the rural-born.

Conclusions. The intensity of the factor causing the seasonal variation of births in schizophrenia may be decreasing. Urban birth may be emerging as a risk factor for schizophrenia in Finland, as elsewhere.

Background. There is conflicting evidence concerning the magnitude of genetic and shared environmental influences on juvenile antisocial behaviour (AB). The use of more than one assessment of AB may yield more accurate estimates of these influences.

Methods. Retrospective reports of antisocial behaviour prior to age 18 were obtained on two occasions from a population-based sample of 3522 adult males from male–male twin pairs: phone interviews (wave 1) and self-report questionnaires obtained 19 months later (wave 2). Structural equation modelling estimated the genetic and environmental influences on reliably-measured AB. Factors related to participation of co-twin at wave 1, attrition between waves 1 and 2, and reliability of wave 1 and wave 2 assessments were also investigated.

Results. Twin analyses revealed that genetic, shared environmental, and non-shared environmental influences accounted for approximately 33% (95% CI = 9–57%), 31% (95% CI = 10–51%) and 36% (95% CI = 29–44%) of the variance of reliably measured AB, respectively. We also found significant occasion-specific genetic influences on wave 1 AB. Wave 1 AB did not predict wave 1 participation of co-twin or attrition, but was related to reliability. Co-twins of MZ twins and younger twins were more likely to participate at wave 1; attrition was predicted by being a DZ twin, lack of initial participation of co-twin, fewer years of education, and fewer children. Being older, being unmarried, and having less psychopathology were associated with greater reliability.

Conclusions. When measurement error is taken into account, both genetic and shared environmental factors are significant influences on juvenile AB, accounting for approximately one- third of variation. The origin of the specific genetic influences on wave 1 AB is unclear, but may be due to factors related to measurement.

Background. Suicide prevention is a health priority in many countries. Improved management of suicide risk may improve suicide prevention. This study aimed to assess the feasibility of health district-wide training in the assessment and management of people at risk of suicide; and to assess the impact of training on assessment and management skills.

Methods. Staff in three health care settings, namely primary care, accident and emergency departments and mental health services (N = 359), were offered suicide risk management training in a district-wide programme, using a flexible ‘facilitator’ approach. The main outcomes were the rate of attendance at training, and changes in suicide risk assessment and management skills following training.

Results. It was possible to deliver training to 167 health professionals (47% of those eligible) during a 6 month training period. This included 95 primary care staff (39%), 21 accident and emergency staff (42%) and 51 mental health staff (78%). Of these, 103 (69%) attended all training. A volunteer sample of 28 staff who underwent training showed improvements in skills in the assessment and management of suicide risk. Satisfaction with training was high. The expected costs of district-wide training, if it were able to produce a 2·5% reduction in the suicide rate, would be £99747 per suicide prevented and £3391 per life year gained.

Conclusions. Training in the assessment and management of suicide risk can be delivered to approximately half the targeted staff in primary care, accident and emergency departments and mental health services. The current training package can improve skills and is well accepted. If it were to produce a modest fall in the suicide rate, such training would be cost-effective. However, a future training programme should develop a broader training package to reach those who will not attend.

Background. Previous research suggests that childhood sexual abuse is associated with high rates of retrospectively reported medical utilization and medical problems as an adult. The goal of this study was to determine if abused females have higher rates of medical utilization using self-report and objective measures, compared with non-abused females. A further goal was to determine whether findings of prior research would be replicated when childhood physical abuse level was controlled. This study also examined the moderating impact of depressed mood on current health measures in this population.

Methods. Six hundred and eight women recruited from a health maintenance organization completed self-report measures of health symptoms for the previous month and doctor visits for the previous year. Objective doctor records over a 2 year period were examined for a subset of 136 of these women.

Results. Results showed significantly more self-reported health symptoms and more self-reported doctor visits in abused participants compared with those who reported no childhood history of sexual abuse. Objective doctor visits demonstrated the same pattern with abused participants exhibiting more visits related to out-patient surgery and out-patient internal medicine. In addition, persons who were both sexually abused and depressed tended to visit the emergency room more frequently and to have more in-patient internal medicine and ophthalmology visits than sexually abused participants who reported low depressed mood and non-abused controls.

Conclusions. These results replicate prior studies and suggest that current depression may moderate the relationship between sexual abuse and medical problems in adulthood.