The differences in rates of trauma-related disorders between patients with histories of childhood sexual abuse and those without such histories were examined in a sample of depressed outpatients. One goal of the study was to determine whether childhood sexual abuse is associated with recent suicidal attempts, affect dysregulation, and duration of index depressive episode, independent of posttraumatic stress disorder and borderline personality disorder. The study subjects were 235 treatment-seeking outpatients with major depression. Structured interviews were administered to assess for Axis I and Axis II disorders, childhood sexual abuse, and various clinical features. The results show that having a history of childhood sexual abuse substantially increased the risk of psychiatric morbidity in patients with major depression. Among patients with major depression, those that reported histories of childhood sexual abuse compared to those that did not report such experiences were significantly more likely to present with elevated rates of posttraumatic stress disorder, borderline personality disorder, and multiple axis I disorders. There may be certain enduring disturbances associated with the experience of childhood sexual abuse that play a pivotal role in maintaining a depressive episode. Childhood sexual abuse status was not independently related to affect dysregulation and suicidal attempts. These findings suggest that patients with histories of sexual abuse represent a subgroup of depressed patients that are especially high risk for psychiatric morbidity and a prolonged episode of depression. Unfortunately, no treatment for major depression has been developed or tested that addresses the specific needs of depressed patients with histories of sexual abuse. 2 tables, 40 references