Synergistic effects of child abuse and intimate partner violence on depressive symptoms in women Colleen T. Fogarty a, ⁎ , Lisa Fredman b , Timothy C. Heeren c , Jane Liebschutz d a Department of Family Medicine, University of Rochester, 777 South Clinton Avenue, Rochester, NY 14620, USA b Department of Epidemiology, Boston University School of Public Health, USA c Department of Biostatistics, Boston University School of Public Health, USA d Department of Medicine, Boston University School of Medicine, USA Available online 22 January 2008 Abstract Objective. Few population-based studies have examined the association of both child abuse (i.e., physical and sexual abuse) and intimate partner violence (IPV) with depressive symptoms in women. This study estimated the odds of depressive symptoms over the prior week among women exposed to child abuse or IPV alone, and both child abuse and IPV. Method. Cross-sectional analysis of 7918 women respondents to the 1995 National Violence Against Women Survey (NVAWS). Results. The prevalence of self-reported depressive symptoms was 50.2% in women reporting both child abuse and IPV, followed by women reporting IPV (35.7%) or child abuse alone (34.9%), and 25.2% in those with no reported abuse. Multivariable logistic regression found that women who reported both child abuse and IPV had over twice the odds of depressive symptoms than women reporting no abuse (adjusted odds ratio, OR = 2.80 95% confidence interval, CI = 2.35, 3.32). Smaller, though significantly elevated odds of depression were found among respondents with child abuse only (OR = 1.63, 95% CI 1.42, 1.86) and IPV only (OR = 1.55, 95% CI 1.30, 1.84). Conclusion. The results demonstrate a super-additive risk of depressive symptoms in women exposed to both child abuse and IPV, and underscore the adverse psychological effects of these exposures. © 2007 Elsevier Inc. All rights reserved. Keywords: Child abuse; Cross-sectional studies; Depressive disorder; Spouse abuse; Mental disorders; Multivariate analysis; Violence; Women's health Introduction U.S. women have a high prevalence of depression, which results in considerable morbidity and social impairment. (Kessler, 2003; Kessler et al., 2003) There is evidence that child abuse (Chapman et al., 2004; Tjaden and Thoennes, 2000a; Kessler et al., 1997) and intimate partner violence (IPV) (Coker et al., 2002; Kramer et al., 2004; McCauley et al., 1997) are independent risk factors for depressive symptoms in adult women. Studies in clinical populations (McCauley et al., 1997; Roberts et al., 1998a; Thompson et al., 2003; Nicolaidis et al., 2004) suggest that these two factors may have a synergistic effect on the development of depressive symptoms: i.e., persons exposed to both child abuse and IPV have a greater risk of developing depressive symptoms than persons who experienced either condition alone. Because the prevalence of abuse and depressive symptoms among women in clinical settings is higher than in the general population, it is unknown whether this asso- ciation occurs in community-based populations. This study examined the combined associations of child abuse and IPV on depressive symptoms in a national, community-based sample of women, the National Violence Against Women Survey (NVAWS). Child abuse comprises physical abuse, sexual abuse, neglect, and emotional abuse of a person under the age of majority. (Merrick and Browne, 1999; Behl et al., 2003) The measured prevalence of child abuse varies depending on definition and methodology. According to the National Longitudinal Study of Adolescent Health (U.S.), 28% of teens reported physical assault Available online at www.sciencedirect.com Preventive Medicine 46 (2008) 463 – 469 www.elsevier.com/locate/ypmed ⁎ Corresponding author. Fax: +1 585 442 8319. E-mail address: colleen_fogarty@urmc.rochester.edu (C.T. Fogarty). 0091-7435/$ - see front matter © 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2007.12.009