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

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

Source: The Lancet

Adults with major depressive disorder who have a history of childhood trauma experience improvement in symptoms after pharmacotherapy, psychotherapy, or combination treatment.

The results of a new study, published in The Lancet Psychiatrysuggest 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 the age of 18) is known to be a risk factor for the development of major depressive disorder in adulthood. more frequent, and with an increased risk of morbidity.

Previous studies have suggested that adults and adolescents with depression and childhood trauma were about 1.5 times more likely to fail to respond or recover 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 for adults with childhood trauma and is also the first to compare the effect of active treatment with a control condition (waiting list, placebo or routine care) on this population.

“About 46% of adults with depression have a history of childhood trauma, and the prevalence is even higher for chronic depression patients. It is therefore important to determine whether current treatments offered for major depressive disorder are effective for patients with childhood trauma,” says Ph.D. candidate and first author of the study, Erika Kuzminskaite.

The researchers used data from 29 clinical trials of pharmacotherapy and psychotherapy 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. Most clinical trials (15.51.7%) were conducted in Europe, followed by North America (9.31%). Depression severity was assessed using the Beck Depression Inventory (BDI) or Hamilton Rating Scale for Depression (HRSD).

The three research questions examined were: whether childhood trauma patients were more severely depressed prior to treatment, whether there were more adverse outcomes after active treatments for pediatric trauma patients, and whether childhood trauma patients benefited less from active treatment than from the control condition.

Consistent 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 considering symptom severity when calculating the treatment effects.

Although patients with childhood trauma reported more depressive symptoms at both the beginning and end of treatment, they experienced a similar improvement in symptoms compared to patients without a history of childhood trauma.

The dropout rates were also similar for patients with and without childhood trauma. The measured effectiveness of treatment did not vary by type of childhood trauma, depression diagnosis, method of assessment of childhood trauma, study quality, year, treatment type, or duration.

“The discovery that patients with depression and childhood trauma experience a comparable treatment outcome compared to patients without trauma may give hope to people who have experienced childhood trauma. Nevertheless, residual symptoms after treatment in patients with childhood trauma deserve more clinical attention, as additional interventions may still be needed .

“To make further meaningful progress and improve outcomes for individuals with childhood trauma, future research is needed to examine the outcomes of long-term treatment and the mechanisms through which childhood trauma exerts its long-lasting effects,” says Erika Kuzminskaite.

This shows a sad child
Previous studies have suggested that adults and adolescents with depression and childhood trauma were about 1.5 times more likely to fail to respond or recover after pharmacotherapy, psychotherapy, or combination treatment, than those without childhood trauma. Image is in the public domain

The authors acknowledge some limitations of this study, including a wide variety of results from the studies included in the meta-analysis, and all childhood trauma cases 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 after treatment and are characterized by a high risk of relapse, which means they may benefit significantly less from treatment than patients without childhood trauma over the long term. term. The study design also did not take into account gender differences.

Antoine Yrondi, University of Toulouse, France (who was not involved in the study), wrote in a linked comment: “This meta-analysis could provide a message of hope to patients with childhood trauma that evidence- based psychotherapy and pharmacotherapy could improve depressive symptoms.

“Doctors should keep in mind, however, that childhood trauma may be associated with clinical features that may make it more difficult to achieve complete symptomatic remission, and therefore have an impact on daily functioning.”

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About this research news on depression and child abuse

Author: press office
Source: The Lancet
Contact: Press Agency – The Lancet
Image: The image is in the public domain

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


Abstract

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

Background

Childhood trauma is a common and potent risk factor for developing major depressive disorder in adulthood, associated with earlier-onset, more chronic or recurrent symptoms and a greater likelihood of co-morbidities. Some research indicates that evidence-based pharmacotherapies and psychotherapies for adult depression may be less effective in patients with a history of childhood trauma than patients without childhood trauma, but the findings are inconsistent. Therefore, we examined whether individuals with major depressive disorder, including chronic forms of depression, and a reported history of childhood trauma, had more severe depressive symptoms before treatment, had more adverse treatment outcomes after active treatments, and were less likely to benefit from active treatments. treatments compared to a control condition, compared to subjects with depression without childhood trauma.

Methods:

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

findings

Of 10 505 publications, 54 studies met the inclusion criteria, of which 29 (20 RCTs and nine open studies) provided data from up to 6830 participants (age range 18-85 years, male and female individuals and specific ethnicity data not available). More than half (4268 [62%] of 6830) of patients with major depressive disorder reported a history of childhood trauma. Despite more severe depression at baseline (g=0 202, 95% CI 0.145 to 0.258, l2=0%), patients with childhood trauma benefited as much from active treatment as patients with no history of childhood trauma (difference in treatment effect between groups g=0.016, –0.094 to 0.125, l2=44 3%), with no significant difference in active treatment effects (vs control condition) between subjects with and without childhood trauma (child trauma g=0 605, 0.294 to 0 916, l2=58.0%; no childhood trauma g=0.178, –0.195 to 0.552, l2=67·5%; difference between groups p=0.051), and comparable dropout rates (risk ratio 1.063, 0.945 to 1.195, l2=0%). The findings did not differ significantly by type of childhood trauma, study design, depression diagnosis, method of assessment of childhood trauma, study quality, year, or treatment type or duration, but differed by country (North American studies showed greater treatment effects for patients with childhood trauma; false discovery rate corrected p= 0.0080). Most studies had a moderate to high risk of bias (21 [72%] of 29), but the sensitivity analysis in low-bias studies yielded similar findings as if all studies were included.

Interpretation

In contrast to previous studies, we found evidence that the symptoms of patients with major depressive disorder and childhood trauma improve significantly after pharmacological and psychotherapeutic treatments, despite their higher severity of depressive symptoms. Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder, regardless of the trauma status in childhood.

Financing

No.

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