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 following 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 combined 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 age 18) is known to be a risk factor for the development of major depressive disorder in adulthood, often resulting in symptoms of earlier onset and longer duration. more frequently recurrent and with a greater risk of morbidity.

Previous studies have suggested that adults and adolescents with depression and childhood trauma were approximately 1.5 times more likely to fail to respond or remit after pharmacotherapy, psychotherapy, or combined 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 (waitlist, placebo or usual care) for this population.

“About 46% of adults with depression have a history of childhood trauma, and for 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 childhood trauma patients,” 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. 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 tested were: whether childhood trauma patients were more severely depressed before treatment, whether there were more unfavorable outcomes after active treatments for childhood trauma patients, and whether childhood trauma patients were less likely to benefit from the active treatment than the control condition. .

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

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

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

“The 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 after treatment in patients with childhood trauma warrant further clinical attention, as additional interventions may still be necessary.

“To provide 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 long-term effects,” she says. Erika Kuzminskaite.

Previous studies have suggested that adults and adolescents with depression and childhood trauma were approximately 1.5 times more likely to fail to respond or remit after pharmacotherapy, psychotherapy, or combined treatment than those without childhood trauma. The image is in the public domain

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

The meta-analysis focused on symptom reduction during the acute phase of treatment, but people with depression and childhood trauma often show residual symptoms after treatment and are at high risk of relapse, so they may benefit of treatment significantly less than patients without childhood trauma. eventually. The study design also did not take gender differences into account.

Writing in a linked commentary, Antoine Yrondi of the University of Toulouse, France (who was not involved in the research), said: “This meta-analysis could allow a hopeful message to be delivered to patients with childhood trauma that psychotherapy and pharmacotherapy based in the evidence they could improve depressive symptoms.

“However, clinicians should be aware that childhood trauma could be associated with clinical features that may hinder complete symptomatic remission and thus impact daily functioning.”

See also

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About this research news about depression and child abuse

Author: Press Office
Source: The Lancet
Contact: Press Office – The Lancet
Image: The image is in the public domain

Original research: Closed access
“Efficacy 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


Summary

Treatment efficacy and effectiveness 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 greater likelihood of comorbidities. Some studies indicate that evidence-based pharmacotherapies and psychotherapies for adult depression may be less effective in patients with a history of childhood trauma than in patients without childhood trauma, but results are inconsistent. Therefore, we examined whether people 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 unfavorable treatment outcomes after active treatments, and had less probabilities of benefiting from active activity. treatments relative to a control condition, compared to individuals with depression without childhood trauma.

methods

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

discoveries

From 10,505 publications, 54 trials met the inclusion criteria, of which 29 (20 RCTs and nine open trials) provided data from a maximum of 6,830 participants (age range 18–85 years, male individuals and female and ethnicity-specific data not available). More than half (4268 [62%] of 6830) of patients with major depressive disorder reported a history of childhood trauma. Despite having more severe depression at baseline (g=0·202, 95% CI: 0.145 to 0.258, me2= 0%), patients with childhood trauma benefited from active treatment similarly to patients without a history of childhood trauma (treatment effect difference between groups g = 0.016, -0.094 to 0.125, me2=44·3%), without any significant difference in the effects of the active treatment (vs control condition) between individuals with and without childhood trauma (childhood trauma g=0.605, 0.294 to 0.916, me2=58·0%; no childhood trauma g=0·178, –0·195 to 0·552, me2=67·5%; difference between groups p=0·051), and similar dropout rates (hazard ratio 1.063, 0.945 to 1.195, me2=0%). Findings did not differ significantly by type of childhood trauma, study design, diagnosis of depression, method of childhood trauma assessment, study quality, year or type, or duration of treatment, but differ by country (US studies showed larger treatment effects for patients with childhood trauma). ; corrected false discovery rate p=0·0080). Most studies had a moderate to high risk of bias (21 [72%] of 29), but sensitivity analysis in low-bias studies gave similar results to when all 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 treatments, despite their greater severity of depressive symptoms. Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder, regardless of childhood trauma status.

financing

none

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