Adults with a history of childhood trauma may benefit from recommended treatments for depression, contrary to current theory

Summary: Patients with major depressive disorder who experienced childhood trauma see improvement in symptoms after psychopharmacological intervention, psychotherapy, or a combination of both.

Source: Name of a scientific medical journal

Adults with major depressive disorder who have experienced childhood trauma experience improvement in symptoms after drug therapy, psychotherapy or combination therapy.

The results of a new study published in Lancet Psychiatrysuggest that, contrary to current theory, these common treatments for depressive disorders are effective in childhood trauma patients.

Childhood trauma (defined as emotional / physical neglect or emotional / physical / sexual abuse before the age of 18) is known to be a risk factor for developing major depression in adulthood, often causing symptoms that appear earlier, last longer / are more likely to recur and with increased risk of morbidity.

Earlier studies suggested that adults and adolescents with childhood depression and trauma were approximately 1.5 times more likely to be unresponsive or remitted after drug therapy, psychotherapy, or combination therapy than those without childhood trauma.

“This study is the largest of its kind to look at the efficacy of treating depression in adults with childhood trauma, and it is also the first to compare the effect of active treatment with the control status (waiting list, placebo, or ordinary care) for this population.

“About 46% of adults with depression have a childhood history of trauma, and the incidence is even higher for people with chronic depression. Therefore, it is important to determine whether current therapies for major depressive disorders are effective for childhood trauma patients, ”says Dr. Candidate and first author of the study by Erika Kuzminskaite.

The researchers used data from 29 pharmacotherapy and psychotherapy clinical trials to treat major depressive disorder in adults, involving up to 6,830 patients. Of the participants, 4,268 or 62.5% reported a history of childhood trauma. Most of the clinical trials (15, 51.7%) were conducted in Europe followed by North America (9, 31%). Depression severity measures were determined using the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HRSD).

The three research questions examined were: were childhood trauma patients more depressed prior to treatment, were there more adverse outcomes from active treatment of childhood trauma patients, and were childhood trauma patients less likely to receive active treatment than controls.

In line with previous studies, childhood trauma patients showed a greater severity of symptoms at baseline than patients without childhood trauma, highlighting the importance of considering symptom severity when calculating treatment effects.

Although patients with childhood trauma reported more symptoms of depression both at the beginning and end of treatment, they experienced a similar improvement in symptoms compared to patients with no history of childhood trauma.

Discontinuation rates were also similar for patients with and without childhood trauma. The measured efficacy of treatment did not differ depending on the type of childhood injury, diagnosis of depression, method of assessment of childhood injury, quality of the study, year, type or duration of treatment.

“The finding that childhood depression and trauma patients experience similar treatment outcomes compared to non-traumatic patients may give hope to those who experienced childhood trauma. Nevertheless, residual symptoms following treatment of childhood trauma patients require more clinical attention as additional interventions may still be needed.

“To ensure further significant progress and improve outcomes in people with childhood trauma, future research is needed to investigate the long-term outcomes and the mechanisms by which childhood trauma has long-lasting effects,” says Erika Kuzminskaite.

Earlier studies suggested that adults and adolescents with childhood depression and trauma were approximately 1.5 times more likely to be unresponsive or remitted after drug therapy, psychotherapy, or combination therapy than those without childhood trauma. The image is in the public domain

The authors acknowledge some of the limitations of this study, including the wide variety of results among the studies included in the meta-analysis, and all childhood trauma cases are reported retrospectively.

The meta-analysis focused on symptom relief during the acute phase of treatment, but those with childhood depression and trauma often show residual symptoms after treatment and are at high risk of recurrence, and therefore may benefit much less from treatment than patients without childhood trauma eventually. The study design also did not take into account gender differences.

Writing in a related commentary, Antoine Yrondi of the University of Toulouse in France (who was not involved in the research) said: “This meta-analysis could give childhood trauma patients hope that evidence-based psychotherapy and drug therapy can improve depressive symptoms.

“However, physicians should bear in mind that childhood trauma may be related to clinical features that may make it difficult to achieve complete remission of symptoms and thus affect daily functioning.”

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About this news from child abuse and depression research

Author: Press office
Source: Name of a scientific medical journal
Contact: Press Office – The Lancet
Image: The image is in the public domain

Original research: Closed access.
“Efficacy and efficacy of treatment in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis” by Erika Kuzminskaite et al. Lancet Psychiatry


Abstract

Efficacy and efficacy of treatment in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis

Background

Childhood trauma is a common and potent risk factor for the development of major depression in adulthood with an earlier onset, more chronic or recurrent symptoms, and an increased likelihood of comorbidities. Some studies indicate that evidence-based pharmacotherapy and psychotherapy for adult depression may be less effective in patients with a childhood history of trauma than in patients without childhood trauma, but the results are inconsistent. Therefore, we examined whether people with major depressive disorders, including chronic forms of depression, and with a history of childhood trauma, had more severe depressive symptoms before treatment, had more adverse treatment outcomes after active treatment, and were less likely to receive active treatment. treatment relative to the control state, compared with depressed people without childhood trauma.

Methods

We conducted a comprehensive meta-analysis (PROSPERO CRD42020220139). The study selection combined a search of bibliographic databases (PubMed, PsycINFO, and Embase) from November 21, 2013 to March 16, 2020, and full-text randomized clinical trials (RCTs) identified from several sources (1966 to 2016-19). to identify articles in English. Randomized trials and open label trials comparing the efficacy or efficacy of evidence-based pharmacotherapy, psychotherapy or combination intervention in adult patients with depressive disorder and the presence or absence of childhood trauma were included. Two independent researchers identified the characteristics of the research. Group data for effect size calculations were requested from the study authors. The primary outcome was the change in depression severity from baseline to the end of the acute phase of treatment, expressed as standardized effect size (Hedges g). Meta-analyzes were performed using random effect models.

Results

Of the 10,505 publications, 54 studies met the inclusion criteria, of which 29 (20 randomized trials and nine open-label trials) provided data for up to 6,830 participants (age range 18-85 years, male and female, and no data on ethnicity). More than half (4268 [62%] 6,830) patients with major depressive disorder reported a childhood history of injury. Despite more severe depression at baseline (g = 0.202, 95% CI 0.145 to 0.258, AND2= 0%), patients with childhood injuries benefited from active treatment as did patients with no history of childhood injuries (treatment effect difference between groups g = 0.016, -0.094 to 0.125, AND2= 44.3%), with no significant difference in active treatment effects (vs control status) between persons with and without childhood injuries (childhood trauma g = 0.605, 0.294 to 0.916, AND2= 58.0%; no trauma in childhood g = 0.178, -0.195 to 0.552, AND2= 67.5%; difference between groups p = 0.051) and similar dropout rates (hazard ratio 1.063, 0.945 to 1.195, AND2= 0%). The results did not differ significantly by type of childhood injury, study design, diagnosis of depression, method of childhood injury assessment, study quality, year, type, or duration of treatment, but varied by country (North American studies showed greater treatment outcomes in trauma patients in childhood; adjusted false discovery rate p = 0.080). The risk of bias was moderate to high in most studies (21 [72%] of 29), but the sensitivity analysis of the low error studies gave similar results as when all the studies were included.

Interpretation

Contrary to previous studies, we found evidence that the symptoms of patients with major depressive disorder and childhood trauma significantly improve after pharmacological and psychotherapeutic treatment, despite the greater severity of depressive symptoms. Evidence-based psychotherapy and drug therapy should be offered to patients with major depressive disorder, irrespective of the state of childhood trauma.

Financing

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