Summary: Patients with major depression in childhood experience improvement in symptoms following psychopharmacological intervention, psychotherapy, or a combination of both.
Source: The Lancet
Major depressive disorder in adults with a history of childhood trauma shows symptom improvement after pharmacotherapy, psychotherapy, or combined treatment.
The results of a new study published in Lancet PsychiatryContrary to current theory, these common treatments for major depressive disorder suggest that they are effective for patients with childhood trauma.
Childhood trauma (emotional/physical neglect or emotional/physical/sexual abuse defined before age 18) is known to be a risk factor for the development of major depressive disorder in adulthood, often with earlier onset, longer duration of symptoms/recurrence, and increased risk of comorbidity.
Previous studies have shown that adults and adolescents with depression and childhood trauma are 1.5 times more likely to fail to respond or drop out after pharmacotherapy, psychotherapy, or combination therapy than those without childhood trauma.
“This study is the largest of its kind to look at the effectiveness of treatments for depression in adults in childhood and is also the first to compare active treatment with a control condition (waiting list, placebo, or usual care) in this population.
“Forty-six percent of adults with depression have a history of childhood trauma, and the prevalence is even higher for people with chronic depression. Therefore, it is important to determine whether current treatments for major depressive disorder are effective for patients with childhood illness,” says Erika Kuzminskaite, Ph.D. candidate and first author of the study.
The researchers used data from 29 clinical trials of pharmacotherapy and psychotherapy for major depressive disorder in adults, which included a total of 6,830 patients. Of the participants, 4,268 or 62.5% reported a history of childhood trauma. Most 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 Rating Scale for Depression (HRSD).
The three research questions tested were: whether childhood trauma patients were more anxious before treatment, whether childhood trauma patients had poorer outcomes after active treatments, and whether childhood trauma patients were less likely to use active treatments than controls.
According to the results of previous studies, patients affected by childhood pain showed more symptoms at the beginning of treatment than patients without childhood pain, which shows the importance of taking symptoms into account when calculating treatment outcomes.
Although childhood trauma patients reported more depressive symptoms at the beginning and end of treatment, compared to patients without a history of childhood trauma, similar symptoms improved.
Treatment dropout rates were similar for patients with and without childhood trauma. Measured treatment effectiveness did not differ by type of childhood trauma, depression diagnosis, childhood trauma assessment method, study quality, year, type of treatment, or length of treatment.
“Knowing that patients with depression and childhood trauma experience similar treatment outcomes compared to non-traumatic patients offers hope for people with childhood trauma. However, residual symptoms following treatment in patients with childhood trauma require further clinical attention as additional interventions may still be needed.”
“In order to provide more meaningful progress and improve outcomes for individuals affected by childhood illness, future research is important to examine the long-term outcomes of treatment and the mechanisms by which childhood illness affects its lasting effects,” says Erika Kuzminskaite.
The authors acknowledge some limitations to this study, including the highly variable results among the studies included in the meta-analysis and the fact that all childhood trauma was reported retrospectively.
Although the meta-analysis focused on symptoms during acute treatment, people with depression and childhood illness often show residual symptoms after treatment and are known to be at higher risk of relapse. In the long run. The study design also did not account for gender differences.
Writing in a related commentary, Antoine Yrondi of the University of Toulouse, France (who was not involved in the study) said, “This meta-analysis allows for a promising message about evidence-based psychotherapy and pharmacotherapy for patients with childhood pain.” Improving symptoms of depression.
“However, doctors should remember that childhood pain can be associated with clinical features that make it very difficult to achieve complete symptomatic remission and, therefore, affect daily activities.”
So depression and child abuse research news
Preliminary study: Closed access.
“Efficacy and efficacy of treatment in adults with major depression and a history of childhood trauma: a systematic review and meta-analysis.” by Erika Kuzminskyte et al. Lancet Psychiatry
Efficacy and efficacy of treatment in adults with major depression and a history of childhood trauma: a systematic review and meta-analysis.
Childhood risk is a common and powerful risk factor for developing high dyslexia with early onset, severe or frequent symptoms, and a high probability of shock. Some studies suggest that evidence-based pharmacotherapy and psychotherapies for adult depression may be less effective in patients with a history of childhood trauma than in patients without childhood trauma, but the findings are inconsistent. Therefore, we examined whether subjects with major depression, chronic depression, and a reported history of childhood trauma were more likely to have more severe depression before treatment, had poorer treatment outcomes after active treatments, and were less likely to use active treatments. In a treatment-matched control condition, compared to depressed individuals without childhood trauma.
We performed a comprehensive meta-analysis (PROSPERO CRD42020220139). 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) from multiple sources (1966 to 2016–2019). To identify articles in English. RCTs and open trials comparing the presence and absence of evidence-based pharmacotherapy, psychotherapy, or a combination intervention for adult patients with depressive disorder and childhood trauma. Two independent researchers determined the study characteristics. For effect size calculation, group data were requested from researchers. The primary outcome was the change in depression severity from baseline to the end of the acute treatment phase, expressed as a standardized effect size (Hedges’ g). Meta-analyses were performed using random-effects models.
From 10 505 publications, 54 trials met the inclusion criteria, of which 29 (20 RCTs and nine open trials) contributed data on a maximum of 6830 participants (age range 18-85 years, male and female individuals and separate race data was not available). More than half (4268 [62%] 6830) patients with major depressive disorder reported childhood trauma. Although there was more severe depression at baseline (g=0·202, 95% CI 0·145 to 0·258, no2=0%), patients with a history of childhood trauma benefited from the same active treatment as patients without a history of childhood trauma (treatment effect difference between groups g=0·016, -0·094 to 0·125, no2= 44·3%), no difference in active treatment outcomes (vs control condition) between individuals with and without childhood trauma (childhood trauma g=0·605, 0·294 to 0·916, no2=58·0%; No childhood trauma g=0·178, –0·195 to 0·552; no2= 67·5%; between-group difference p=0·051), and similar dropout rates (hazard ratio 1·063, 0·945 to 1·195; no2=0%). Findings did not differ significantly by type of childhood trauma, study design, depression diagnosis, method of childhood trauma assessment, study quality, year, or type or length of treatment, but did vary by country (North American studies showed greater treatment effect for patients with childhood trauma) False discovery rate adjusted p=0·0080). Most studies had a moderate to high risk of bias (21 [72%] 29), but sensitivity analysis in studies with low bias yielded similar findings when all studies were included.
In contrast to previous studies, we found evidence that patients with major depressive disorder and childhood illness showed significant improvement in depressive symptoms after pharmacological and psychotherapeutic treatments. Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depression regardless of childhood trauma.