{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:50:38Z","timestamp":1790470238129,"version":"4.1.0"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2015,3,1]],"date-time":"2015-03-01T00:00:00Z","timestamp":1425168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,3,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Sexual dysfunction is common among depressed adults. Childhood sexual abuse (CSA) and depressive symptomology are among the risk factors for sexual dysfunction, and these factors may interact to predict adult relationship functioning. Several models have been developed postulating interactions between these variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>We tested models of the effects of CSA and elucidate the associations between CSA, sexual dysfunction, depression severity, anxiety, and relationship quality in chronically depressed adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Baseline data from 808 chronically depressed outpatients enrolled in the Research Evaluating the Value of Augmenting Medication with Psychotherapy study were evaluated using structural equation modeling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>The Inventory of Depressive Symptomology, self-report version (IDS-SR) assessed depression severity, and the Mood and Anxiety Symptom Questionnaire Anxious Arousal subscale assessed anxiety. Sexual function was assessed with the Arizona Sexual Experiences Scale (ASEX), and the Quality of Marriage Index (QMI) assessed relationship quality for patients in stable relationships.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CSA scores predicted depression severity on the IDS-SR, as well as lower relationship quality and sexual satisfaction. ASEX scores were significantly associated with depression severity but were not correlated with the QMI. Two models were evaluated to elucidate these associations, revealing that (i) depression severity and anxious arousal mediated the relationship between CSA and adult sexual function, (ii) anxious arousal and sexual functioning mediated the association between CSA and depression symptoms, and (iii) when these models were combined, anxious arousal emerged as the most important mediator of CSA on depression which, in turn, mediated associations with adult sexual satisfaction and relationship quality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although CSA predicts lower relationship and sexual satisfaction among depressed adults, the long-term effects of CSA appear to be mediated by depressive and anxious symptoms. It is important to address depression and anxiety symptoms when treating patients with CSA who present with sexual dysfunction or marital concerns.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jsm.12727","type":"journal-article","created":{"date-parts":[[2014,10,20]],"date-time":"2014-10-20T11:18:55Z","timestamp":1413803935000},"page":"813-823","source":"Crossref","is-referenced-by-count":34,"title":["Mediators of Sexual Functioning and Marital Quality in Chronically Depressed Adults with and Without a History of Childhood Sexual Abuse"],"prefix":"10.1093","volume":"12","author":[{"given":"Boadie W.","family":"Dunlop","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences , Atlanta, GA , USA"},{"name":"Emory University , Atlanta, GA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Biostatistics , Atlanta, GA , USA"},{"name":"Emory University , Atlanta, GA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin N.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences , Atlanta, GA , USA"},{"name":"Emory University , Atlanta, GA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel N.","family":"Klein","sequence":"additional","affiliation":[{"name":"Departments of Psychology and Psychiatry , Stony Brook, NY , USA"},{"name":"Stony Brook University , Stony Brook, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan J.","family":"Gelenberg","sequence":"additional","affiliation":[{"name":"Pennsylvania State University , Hershey, PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara O.","family":"Rothbaum","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences , Atlanta, GA , USA"},{"name":"Emory University , Atlanta, GA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Thase","sequence":"additional","affiliation":[{"name":"Department of Psychiatry , Philadelphia, PA , USA"},{"name":"Perelman School of Medicine , Philadelphia, PA , USA"},{"name":"University of Pennsylvania , Philadelphia, PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James H.","family":"Kocsis","sequence":"additional","affiliation":[{"name":"Department of Psychiatry , New York, NY , USA"},{"name":"Weill Cornell Medical College , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2015,3,1]]},"reference":[{"key":"2023010709210979900_bb0010","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.cpr.2009.06.007","article-title":"Sexual dysfunction in depression and anxiety: Conceptualizing sexual dysfunction as part of an internalizing dimension","volume":"29","author":"Laurent","year":"2009","journal-title":"Clin Psychol Rev"},{"key":"2023010709210979900_bb0015","doi-asserted-by":"crossref","first-page":"2831","DOI":"10.1111\/j.1743-6109.2011.02352.x","article-title":"Improvement in sexual quality of life of the female partner following vardenafil treatment of men with erectile dysfunction: A randomized, double-blind, placebo-controlled study","volume":"8","author":"Mart\u00edn-Morales","year":"2011","journal-title":"J Sex Med"},{"key":"2023010709210979900_bb0020","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/j.1743-6109.2007.00652.x","article-title":"Review of the empirical evidence for a theoretical model to understand the sexual problems of women with a history of CSA","volume":"5","author":"Rellini","year":"2008","journal-title":"J Sex Med"},{"key":"2023010709210979900_bb0025","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1111\/j.1743-6109.2010.01778.x","article-title":"Definitions\/epidemiology\/risk factors for sexual dysfunction","volume":"7","author":"Lewis","year":"2010","journal-title":"J Sex Med"},{"key":"2023010709210979900_bb0030","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1111\/j.1743-6109.2012.02709.x","article-title":"Bidirectional association between depression and sexual dysfunction: A systematic review and meta-analysis","volume":"9","author":"Atlantis","year":"2012","journal-title":"J Sex Med"},{"key":"2023010709210979900_bb0035","first-page":"72","article-title":"Marital and sexual dysfunction in depressed women","volume":"6","author":"Paykel","year":"1972","journal-title":"Med Aspects Hum Sex"},{"key":"2023010709210979900_bb0040","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/JCP.0b013e318205a670","article-title":"Major depressive disorder: Gender differences in symptoms, life quality, and sexual function","volume":"31","author":"Lai","year":"2011","journal-title":"J Clin Psychopharmacol"},{"key":"2023010709210979900_bb0045","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1080\/10532528.2002.10559808","article-title":"Child sexual abuse: Associations with the sexual functioning of adolescents and adults","volume":"13","author":"Loeb","year":"2002","journal-title":"Annu Rev Sex Res"},{"key":"2023010709210979900_bb0050","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/S0145-2134(96)00180-9","article-title":"The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement biases","volume":"21","author":"Gorey","year":"1997","journal-title":"Child Abuse Negl"},{"key":"2023010709210979900_bb0055","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1034\/j.1600-0447.2002.02094.x","article-title":"Gender differences in depression risk and coping factors in a clinical sample","volume":"106","author":"Wilhelm","year":"2002","journal-title":"Acta Psychiatr Scand"},{"key":"2023010709210979900_bb0060","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s10508-005-6277-6","article-title":"Sexual abuse in childhood and sexual dysfunction in adulthood: An Australian population-based study","volume":"34","author":"Najman","year":"2005","journal-title":"Arch Sex Behav"},{"key":"2023010709210979900_bb0065","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/0145-2134(96)00085-3","article-title":"Childhood sexual abuse as a predictor of adult female sexual dysfunction: A study of couples seeking sex therapy","volume":"20","author":"Sarwer","year":"1996","journal-title":"Child Abuse Negl"},{"key":"2023010709210979900_bb0070","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1080\/01926189608251043","article-title":"Severity of childhood sexual abuse: Symptom differences between men and women","volume":"24","author":"Heath","year":"1996","journal-title":"Am J Fam Ther"},{"key":"2023010709210979900_bb0075","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1177\/088626089004004001","article-title":"Sexual abuse and its relationship to later sexual satisfaction, marital status, religion, and attitudes","volume":"4","author":"Finkelhor","year":"1989","journal-title":"J Interpers Violence"},{"key":"2023010709210979900_bb0080","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/0886260505281603","article-title":"Relational outcomes of childhood sexual trauma in female survivors: A longitudinal study","volume":"21","author":"Liang","year":"2006","journal-title":"J Interpers Violence"},{"key":"2023010709210979900_bb0085","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1016\/j.chiabu.2013.05.006","article-title":"PTSD and marital satisfaction in military service members: Examining the simultaneous roles of childhood sexual abuse and combat exposure","volume":"13","author":"Miller","year":"2013","journal-title":"Child Abuse Negl"},{"key":"2023010709210979900_bb0090","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1111\/j.1475-6811.2006.00124.x","article-title":"Childhood trauma and marital outcomes in adulthood","volume":"13","author":"Whisman","year":"2006","journal-title":"Pers Relatsh"},{"key":"2023010709210979900_bb0095","first-page":"1","article-title":"Childhood sexual abuse and the risk for recurrent major depression in Chinese women","volume":"11","author":"Cong","year":"2011","journal-title":"Psychol Med"},{"key":"2023010709210979900_bb0100","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.chiabu.2006.12.018","article-title":"Exposure to childhood sexual and physical abuse and adjustment in early adulthood","volume":"32","author":"Fergusson","year":"2008","journal-title":"Child Abuse Negl"},{"key":"2023010709210979900_bb0105","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1097\/00005053-199403000-00003","article-title":"Effects of childhood trauma on psychological functioning in adults sexually abused as children","volume":"182","author":"Roesler","year":"1994","journal-title":"J Nerv Ment Dis"},{"key":"2023010709210979900_bb0110","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/NMD.0b013e31822142ac","article-title":"Childhood sexual abuse severity and disclosure as predictors of depression among adult African-American and Latina women","volume":"199","author":"Sciolla","year":"2011","journal-title":"J Nerv Ment Dis"},{"key":"2023010709210979900_bb0115","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/BF00994618","article-title":"Type and extent of child abuse as predictors of adult functioning","volume":"7","author":"Wind","year":"1992","journal-title":"J Fam Violence"},{"key":"2023010709210979900_bb0120","doi-asserted-by":"crossref","first-page":"753","DOI":"10.2105\/AJPH.91.5.753","article-title":"Child sexual abuse and subsequent psychopathology: Results from the National Comorbidity Survey","volume":"91","author":"Molnar","year":"2001","journal-title":"Am J Public Health"},{"key":"2023010709210979900_bb0125","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1002\/jclp.10175","article-title":"Cognitive therapy for chronic depression","volume":"59","author":"Riso","year":"2003","journal-title":"J Clin Psychol"},{"key":"2023010709210979900_bb0130","article-title":"Childhood sexual abuse and comorbid PTSD and depression in impoverished women","author":"Pratt","year":"2012"},{"key":"2023010709210979900_bb0135","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s10896-009-9243-6","article-title":"An investigation of posttraumatic stress disorder and depressive symptomatology among female victims of interpersonal trauma","volume":"24","author":"Taft","year":"2009","journal-title":"J Fam Violence"},{"key":"2023010709210979900_bb0140","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1037\/0022-006X.54.2.140","article-title":"Causes of sexual dysfunction: The role of anxiety and cognitive interference","volume":"54","author":"Barlow","year":"1986","journal-title":"J Consult Clin Psychol"},{"key":"2023010709210979900_bb0145","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/978-1-4899-2504-6_12","article-title":"The nature and role of performance anxiety in sexual dysfunction","volume-title":"Handbook of social and evaluation anxiety","author":"Bruce","year":"1990"},{"key":"2023010709210979900_bb0150","first-page":"143","article-title":"Cognitive-affective processes in sexual arousal and sexual dysfunction","volume-title":"The psychophysiology of sex","author":"Wiegel","year":"2007"},{"key":"2023010709210979900_bb0155","first-page":"235","article-title":"Cognitive approaches to depression and suicide","volume-title":"Cognitive defects in the development of mental illness","author":"Beck","year":"1978"},{"key":"2023010709210979900_bb0160","first-page":"47","article-title":"Test of the relationships among different cognitive factors in Beck's Cognitive Model of Depression","volume":"52","author":"Ku","year":"2010","journal-title":"Chinese J Psychol"},{"key":"2023010709210979900_bb0165","first-page":"270","article-title":"Assessing the long-term impact of child sexual abuse: A review and conceptualization","volume-title":"Family abuse and its consequences: New directions in research","author":"Finkelhor","year":"1988"},{"issue":"12-B","key":"2023010709210979900_bb0170","first-page":"6806","article-title":"A test of theory: Four traumagenic dynamics of sexual abuse in a population of adult female sexual abuse survivors","volume":"58","author":"Edwards","year":"1998","journal-title":"Diss Abstr Int"},{"key":"2023010709210979900_bb0175","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1080\/17405629.2012.660789","article-title":"The role of traumagenic dynamics on the psychological adjustment of survivors of child sexual abuse","volume":"9","author":"Cant\u00f3n-Cort\u00e9s","year":"2012","journal-title":"Eur J Dev Psychol"},{"key":"2023010709210979900_bb0180","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/0145-2134(96)00019-1","article-title":"Mediators of the long-term impact of child sexual abuse: Perceived stigma, betrayal, powerlessness, and self-blame","volume":"20","author":"Coffey","year":"1996","journal-title":"Child Abuse Negl"},{"key":"2023010709210979900_bb0185","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1300\/J070v02n03_04","article-title":"Trauma-related beliefs as mediators of sexual abuse impact in adult women survivors: A pilot study","volume":"2","author":"Hazzard","year":"1993","journal-title":"J Child Sex Abus"},{"key":"2023010709210979900_bb0190","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1001\/archgenpsychiatry.2009.144","article-title":"Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: The REVAMP Trial","volume":"66","author":"Kocsis","year":"2009","journal-title":"Arch Gen Psychiatry"},{"key":"2023010709210979900_bb0195","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/j.2044-8260.1967.tb00530.x","article-title":"Development of a rating scale for primary depressive illness","volume":"6","author":"Hamilton","year":"1967","journal-title":"Br J Soc Clin Psychol"},{"key":"2023010709210979900_bb0200","article-title":"ECDEU assessment manual for psychopharmacology","author":"Guy","year":"1976"},{"key":"2023010709210979900_bb0205","article-title":"Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition","author":"First","year":"2002"},{"key":"2023010709210979900_bb0210","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1002\/mpr.79","article-title":"The Inventory of Depressive Symptomatology (IDS): Clinician (IDS-C) and Self-Report (IDS-SR) ratings of depressive symptoms","volume":"9","author":"Rush","year":"2000","journal-title":"Int J Methods Psychiatr Res"},{"key":"2023010709210979900_bb0215","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/S0145-2134(02)00541-0","article-title":"Development and validation of a brief screening version of the Childhood Trauma Questionnaire","volume":"27","author":"Bernstein","year":"2003","journal-title":"Child Abuse Negl"},{"key":"2023010709210979900_bb0220","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1023\/A:1013058625719","article-title":"The childhood trauma questionnaire in a community sample: Psychometric properties and normative data","volume":"14","author":"Scher","year":"2001","journal-title":"J Trauma Stress"},{"key":"2023010709210979900_bb0225","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1080\/009262300278623","article-title":"The Arizona Sexual Experience Scale (ASEX): Reliability and validity","volume":"26","author":"McGahuey","year":"2000","journal-title":"J Sex Marital Ther"},{"key":"2023010709210979900_bb0230","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1111\/j.1743-6109.2009.01548.x","article-title":"The sensitivity of continuous laboratory measures of physiological and subjective sexual arousal for diagnosing women with sexual arousal disorder","volume":"7","author":"Meston","year":"2010","journal-title":"J Sex Med"},{"key":"2023010709210979900_bb0235","doi-asserted-by":"crossref","first-page":"141","DOI":"10.2307\/351302","article-title":"Measuring marital quality: A critical look at the dependent variable","volume":"45","author":"Norton","year":"1983","journal-title":"J Marriage Fam"},{"key":"2023010709210979900_bb0240","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1111\/jmft.12002","article-title":"A preliminary investigation of a telephone administration of the Quality of Marriage Index","volume":"39","author":"Woods","year":"2012","journal-title":"J Marital Fam Ther"},{"key":"2023010709210979900_bb0245","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1037\/0022-3514.66.2.413","article-title":"The role of negative affectivity in the association between attributions and marital satisfaction","volume":"66","author":"Karney","year":"1994","journal-title":"J Pers Soc Psychol"},{"key":"2023010709210979900_bb0250","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1037\/0021-843X.104.1.3","article-title":"Testing a tripartite model: I. Evaluating the convergent and discriminant validity of anxiety and depression symptom scales","volume":"104","author":"Watson","year":"1995","journal-title":"J Abnorm Psychol"},{"key":"2023010709210979900_bb0255","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jad.2012.09.011","article-title":"Are childhood and adult life adversities differentially associated with specific symptom dimensions of depression and anxiety? Testing the tripartite model","volume":"146","author":"van Veen","year":"2013","journal-title":"J Affect Disord"},{"key":"2023010709210979900_bb0260","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1090\/S0002-9947-1943-0012401-3","article-title":"Tests of statistical hypotheses concerning several parameters when the number of observations is large","volume":"54","author":"Wald","year":"1943","journal-title":"Trans Am Math Soc"},{"key":"2023010709210979900_bb0265","article-title":"Applied linear statistical models","author":"Kutner","year":"2005"},{"key":"2023010709210979900_bb0270","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10705519909540118","article-title":"Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives","volume":"6","author":"Hu","year":"1999","journal-title":"Struct Equ Modeling"},{"key":"2023010709210979900_bb0275","article-title":"A step-by-step approach to using the SAS system for factor analysis and structural equation modeling","author":"Hatcher","year":"1994"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609515309528?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609515309528?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/12\/3\/813\/48475659\/jsm_12_3_813.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/12\/3\/813\/48475659\/jsm_12_3_813.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T06:54:18Z","timestamp":1746428058000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/12\/3\/813\/6966724"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,3,1]]},"references-count":54,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2015,3,1]]},"published-print":{"date-parts":[[2015,3,1]]}},"URL":"https:\/\/doi.org\/10.1111\/jsm.12727","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2015,3]]},"published":{"date-parts":[[2015,3,1]]}}}