Childhood Trauma History May Influence Depression Treatment Response

The largest and most comprehensive study of its kind examines the effectiveness of depression treatments in adults with childhood trauma and compares this population to adults diagnosed with major depressive disorder without childhood trauma.

Contrary to previous findings, this study suggests that adults with a history of childhood trauma experience symptom improvement following medication and psychotherapy, currently recommended as treatment for major depressive disorder.

The authors call for therapies to be offered to patients with major depressive disorder, regardless of their childhood trauma status, along with more research into long-term treatment outcomes and post-treatment residual symptoms, as interventions may still be necessary. additional for patients with childhood trauma.

Adults with major depressive disorder who have a history of childhood trauma experience symptom improvement after pharmacotherapy, psychotherapy, or combination treatment. The results of a new study, published in The Lancet Psychiatry , suggest that, contrary to current theory, these common treatments for major depressive disorder are effective for patients with childhood trauma.

Childhood trauma (defined as emotional/physical neglect or emotional/physical/sexual abuse before age 18) is known to be a risk factor for the development of major depressive disorder in adulthood, often resulting in early onset symptoms. earlier, of longer duration/recurring more frequently and with greater risk of morbidity. Previous studies suggested that adults and adolescents with depression and childhood trauma were about 1.5 times more likely to be unresponsive or remitted after pharmacotherapy, psychotherapy, or combination treatment than those without childhood trauma.

“This study is the largest of its kind to look at the effectiveness of depression treatments in adults with childhood trauma and is also the first to compare the effect of active treatment with a control condition (waitlist, placebo, or care). usual) for this population. About 46% of adults with depression have a history of childhood trauma, and among those with chronic depression, the prevalence is even higher. Therefore, it is important to determine whether current treatments offered for major depressive disorder are effective for patients with childhood trauma,” says doctoral candidate and first author of the study, Erika Kuzminskaite.

The researchers used data from 29 clinical trials of pharmacotherapeutic and psychotherapeutic treatments for major depressive disorder in adults, covering a maximum of 6,830 patients. Of the participants, 4,268 or 62.5% reported a history of childhood trauma. The majority of clinical trials (15, 51.7%) were conducted in Europe, followed by North America (9, 31%). Measures of depression severity were determined using the Beck Depression Inventory (BDI) or the Hamilton Rating Scale for Depression (HRSD).

The three research questions evaluated were: whether childhood trauma patients were more severely depressed before treatment, whether there were poorer outcomes after active treatments for childhood trauma patients, and whether childhood trauma patients were less likely to benefit from treatment. active treatment than the control condition.

In line with the results of previous studies, patients with childhood trauma showed greater symptom severity at the start of treatment than patients without childhood trauma, highlighting the importance of taking symptom severity into account when calculating effects. of the treatment.

Although patients with childhood trauma reported more depressive symptoms at both the beginning and end of treatment, they experienced similar improvement in symptoms compared to patients without a history of childhood trauma. Treatment dropout rates were also similar for patients with and without childhood trauma. Measured treatment effectiveness did not vary by type of childhood trauma, depression diagnosis, method of childhood trauma assessment, study quality, year, type of treatment, or duration.

“Finding that patients with depression and childhood trauma experience a similar treatment outcome compared to patients without trauma may give hope to people who have experienced childhood trauma. However, residual symptoms following treatment in patients with childhood trauma warrant increased clinical attention, as additional interventions may still be needed. To provide further meaningful progress and improve outcomes for people with childhood trauma, future research is needed to examine long-term treatment outcomes and the mechanisms through which childhood trauma exerts its lasting effects,” says Erika Kuzminskaite. .

The authors acknowledge some limitations of this study, including a wide variety of results among the studies included in the meta-analysis, and all cases of childhood trauma reported retrospectively. The meta-analysis focused on symptom reduction during the acute treatment phase, but people with depression and childhood trauma often show residual symptoms post-treatment and are characterized by a high risk of relapse and may therefore benefit from treatment. significantly less than patients without childhood trauma. in the long run. The study design also did not take into account differences between genders.

Writing in a linked comment, Antoine Yrondi, University of Toulouse, France (who was not involved in the research) said: “This meta-analysis could make it possible to send a hopeful message to patients with childhood trauma that evidence-based psychotherapy and pharmacotherapy could improve depressive symptoms. However, clinicians should be aware that childhood trauma may be associated with clinical features that may make it difficult to completely remission symptoms and therefore impact daily functioning.”