Pain as a predictor of depression treatment outcomes in women with childhood sexual abuse

Objectives: Childhood sexual abuse (CSA) increases risk for both depression and pain in women. Pain is associated with worse depression treatment response. The contribution of pain to depression treatment outcomes in women with histories of CSA is unknown. This study examined whether clinically significant pain would be associated with worse depression and functioning outcomes among women with CSA histories treated with interpersonal psychotherapy. Method: Participants were 66 women with major depression and CSA who presented to a community mental health center. An interpersonal psychotherapy protocol planned for 14 weekly sessions followed by 2 biweekly sessions. Patients were classified as experiencing high pain or low pain based on reported pain severity and interference with functioning. Generalized estimating equations were used to assess change over time in intent-to-treat analyses. Results: High pain patients entered treatment with greater depression symptom severity than low pain patients. Although both high and low pain patients demonstrated improvement in mood, high-pain patients continued to report more depressive symptoms posttreatment. Furthermore, high pain patients demonstrated less change in their emotion-related role functioning over the course of treatment than low pain patients. Limitations: Small sample size, secondary analyses, lack of a control group, and limited assessment of pain all limit confidence in the findings of this study. Conclusion: Findings support the evidence that depression is particularly severe and difficult to treat in patients with CSA and pain. Clinicians should evaluate pain in depressed patients with CSA histories. Role functioning may prove to be a particularly important target in the treatment of patients with pain.