Preliminary Evidence for Anhedonia as a Marker of Sexual Trauma in Female Adolescents

Figures & data

Table 1 Childhood Trauma Questionnaire Cutoff Scores

Level of Abuse	Emotional Abuse	Physical Abuse	Sexual Abuse	Emotional Neglect	Physical Neglect
None	8	7	5	9	7
Low	12	9	7	14	9
Moderate	15	12	12	17	12
Severe	16+	13+	13+	18+	13+

Notes: CTQ (Childhood Trauma Questionnaire) Manual cutoff scores and categories for each subscale. Example: Those who scored 8 or less in emotional abuse reported minimal or no trauma. Those who scored 9 or higher in emotional abuse reported some level of emotional abuse.

Table 2 Demographics and Clinical Features

	Combined Sample n = 42	Healthy vs Depressed			No Trauma vs Trauma Exposure
		Healthy Control n = 17	Depressed n = 25	p-value	No Trauma n = 18	Trauma Exposure n = 24	p-value
Age (years)	16.33 (2.01)	16.65 (2.21)	16.12 (1.88)	0.43	16.39 (1.94)	16.29 (2.1)	0.367
Female, n (%)	25 (59.5)	12 (70.6)	13 (52)	0.23	11 (61)	14 (58.3)	0.87
CDRS-R scores
Total Score	36.69 (18.42)	19.12 (2.89)	48.64 (14.37)	<0.001	24.33 (11.89)	45.96 (17.06)	<0.001
Anhedonia subscale	4.79 (3.05)	2.12 (0.49)	6.6 (2.69)	<0.001	2.78 (1.96)	6.29 (2.87)	<0.001
QIDS-A17-SR score	8.43 (6.45)	2.71 (2.14)	12.32 (5.38)	<0.001	3.72 (2.22)	11.96 (6.19)	<0.001
CTQ scores
Total Score	37.1 (11.04)	28.35 (3.28)	43.04 (10.49)	<0.001	27.67 (3.73)	44.17 (9.38)	<0.001
Emotional Abuse Scale	9.05 (4.23)	6.06 (1.39)	11.08 (4.31)	<0.001	5.83 (0.99)	11.46 (4.12)	<0.001
Emotional Neglect Scale	8.57 (3.85)	6.41 (1.91)	10.04 (4.17)	0.001	6.06 (1.66)	10.46 (3.97)	<0.001
Physical Abuse Scale	6.45 (2.28)	5.18 (0.53)	7.32 (2.59)	0.001	5.28 (0.67)	7.33 (2.65)	<0.001
Physical Neglect Scale	6.52 (2.2)	5.71 (1.36)	7.08 (2.5)	0.037	5.33 (0.59)	7.42 (2.54)	0.012
Sexual Abuse Scale	6.43 (3.98)	5 (0)	7.4 (4.96)	0.002	5 (0)	7.5 (5.04)	0.001

Notes: Means with standard deviations or % in parentheses. Trauma level is based on CTQ (Childhood Trauma Questionnaire) Manual. Participants who reported none or minimal trauma in all subscales were grouped as “No Trauma”; all others are grouped as “Trauma Exposure”. Anhedonia subscale is the total of CDRS-R items 2 and 3. Sex differences across groups were assessed with Chi-Square. Age and QIDS-A17-SR compared with two samples t-test. CDRS-R total score, Anhedonia subscale score and all CTQ scores were compared with Mann–Whitney U due to skewed distribution of the variable.

Table 3 Sample Characteristics

Participant	Group	Trauma Exposure	Medication(s) and Total Daily Dose	Comorbidities	Sex
1	Dep/Med -	EAS, PAS, ENS	None	Cannabis use	M
2	Dep/Med +	No Trauma	Fluoxetine, methylphenidate hydrochloride ER	ADHD, stimulants were held on day of Scan	F
3	HC	No Trauma	None	None	F
4	HC	No Trauma	None	None	F
5	HC	EAS	None	None	F
6	HC	No Trauma	None	None	F
7	Dep/Med -	EAS, SAS, PNS	None	Panic disorder	M
8	HC	No Trauma	None	None	F
9	Dep/Med +	EAS, SAS, ENS	Sertraline, aripiprazole	None	M
10	Dep/Med +	SAS	Fluoxetine	Alcohol use disorder in remission 8 months, anxiety disorder NOS	F
11	HC	No Trauma	None	None	M
12	HC	No Trauma	None	None	F
13	HC	ENS	None	Subthreshold depressive symptoms	F
14	Dep/Med -	EAS, ENS	None	None	F
15	Dep/Med -	EAS, PAS, ENS, PNS	None	Cannabis use disorder	M
16	Dep/Med +	EAS, SAS	Sertraline	None	F
17	HC	No Trauma	None	None	M
18	Dep/Med -	EAS, PAS, SAS	None	None	F
19	Dep/Med -	EAS, SAS, ENS, PNS	None	Alcohol, cannabis, nicotine	F
20	Dep/Med -	EAS, ENS, PNS	None	None	F
21	Dep/Med -	EAS, SAS	None	ADHD, Osgood-Schlatter Disease	F
22	Dep/Med +	EAS, SAS, ENS	Fluoxetine, dextroamphetamine saccharate	ADHD, GAD, Motor Tic Disorder	M
23	Dep/Med +	EAS, ENS, PNS	Fluoxetine	Cannabis use disorder	M
24	Dep/Med -	EAS, ENS	None	Persistent dysthymic disorder	F
25	Dep/Med -	EAS, PAS, ENS, PNS	Methylphenidate hydrochloride	ADHD	M
26	Dep/Med +	No Trauma	Fluoxetine	Restless leg syndrome, migraines	F
27	Dep/Med -	EAS, PAS, ENS, PNS	None	Persistent dysthymic disorder, cannabis use disorder	F
28	HC	No Trauma	None	None	F
29	HC	PNS	None	None	F
30	Dep/Med +	No Trauma	Duloxetine	ADHD, minor depressive disorder	M
31	Dep/Med -	ENS	Methylphenidate, atomoxetine	ADHD	M
32	Dep/Med +	No Trauma	Bupropion hydrochloride xl	None	M
33	HC	PNS	None	Cannabis use disorder	M
34	HC	No Trauma	None	None	M
35	Dep/Med -	EAS, PAS, SAS, ENS	None	PTSD	F
36	HC	No Trauma	None	Mild concussion history	M
37	Dep/Med +	EAS, PAS, SAS	Fluoxetine	Cannabis use disorder	F
38	Dep/Med +	No Trauma	Amitriptyline	Learning disability, chronic headaches	M
39	Dep/Med +	EAS, PAS, SAS, ENS	Fluoxetine	None	M
40	HC	No Trauma	None	None	F
41	HC	No Trauma	None	None	F
42	HC	No Trauma	None	None	F

Notes: “No Trauma” group consisted of participants who scored in the “None or minimal” category on all subscales. This was defined according to Childhood Trauma Questionnaire Manual. The cut-off scores for each scale are shown in Table 1.

Abbreviations: EAS, Emotional Abuse Scale; PAS, Physical Abuse Scale; SAS, Sexual Abuse Scale; ENS, Emotional Neglect Scale; PNS, Physical Neglect Scale.

Table 4 Generalized Linear Model Results

		β	SE	95% CI for β	p-value
CTQ Total Score		2.485	0.41	1.689–3.281	<0.001
Emotional Abuse		0.93	0.16	0.619–1.241	<0.001
Emotional Neglect		0.67	0.17	0.346–0.994	<0.001
Physical Abuse		0.228	0.11	0.014–0.443	0.037
Physical Neglect		0.306	0.1	0.109–0.504	0.002
Sexual Abuse		0.364	0.19	−0.014–0.743	0.059

Notes: CTQ total scores and 5 subscale association with CDRS-R Anhedonia Subscale in combined sample (n=42, df=38, 1). Each β and p-value pair represents a separate generalized linear model. Independent variable: CDRS-R Anhedonia Subscale, dependent variable Childhood Trauma Questionnaire scores.

Table 5 Association of Sexual Abuse Score with Sex and Anhedonia Score

			95% CI for β
Parameter	β	SE	Upper	Lower	p-value
CDRS-R Anhedonia Subscale	0.117	0.254	−0.38	0.21	0.64
Sex	−1.349	2.131	−5.53	2.83	0.53
Sex * CDRS-R Anhedonia Subscale	0.751	0.368	0.029	1.47	0.042

Notes: Dependent variable was Childhood Trauma Questionnaire Sexual Abuse Scale. Sample size and degrees of freedom were n=42, df=38, 1.

Figure 1 CTQ Sexual Abuse Scale by Anhedonia in Males and Females.