Summary: Patients with major depressive disorder who experienced childhood trauma see improvement in symptoms after psychopharmacological intervention, psychotherapy, or both.
Adults with major depressive disorder with a history of childhood trauma experience improvement in symptoms after drug, psychotherapy, or combination therapy.
The results of a new study published in Lancet Psychiatrysuggests 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 developing major depressive disorder in adulthood, often resulting in symptoms that appear earlier, last longer/more Frequently, with an increased risk of disease.
Previous studies indicated that adults and adolescents with depression and childhood trauma were about 1.5 times more likely to fail to respond or referral 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 depression treatments for adults with childhood trauma, and is also the first study to compare the effect of active treatment with a control condition (waiting list, placebo, or care-as-usual) population.
About 46% of adults with depression have a history of childhood trauma, and for those with chronic depression the prevalence is even higher. It is therefore important to determine whether current treatments offered for major depressive disorder are effective for patients with childhood trauma. Candidate and first author of the study, Erica Kuzminskite.
The researchers used data from 29 clinical trials of pharmacotherapy and psychotherapy for major depressive disorder in adults, covering a maximum of 6,830 patients. Among the participants, 4268 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 scales were determined using the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HRSD).
The three research questions tested were: whether childhood trauma patients had major depression before treatment, whether there were more unfavorable outcomes after effective treatment for patients with childhood trauma, and whether childhood trauma patients had fewer Potential to benefit from effective treatment from a 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 taking symptom severity into account when calculating treatment effects.
Although patients with childhood trauma reported more depressive symptoms at the beginning and end of treatment, they experienced similar improvement in symptoms compared to patients without a history of childhood trauma.
Dropout rates from treatment were also similar for patients with and without childhood trauma. Treatment efficacy measured did not differ by type of childhood trauma, depression diagnosis, method of assessment of childhood trauma, study quality, year, type or length of treatment.
“The finding that patients with depression and childhood trauma experience the same treatment outcomes when compared to non-traumatized patients could give hope to people who have experienced childhood trauma. However, the symptoms remaining after treatment in patients with childhood trauma They require more clinical attention as additional interventions may still be needed.
“To provide further meaningful progress and improve outcomes for individuals with childhood trauma, future research is necessary to examine long-term treatment outcomes and the mechanisms by which childhood trauma exerts its long-term effects,” says Erica Kuzminskate.
The authors acknowledge some limitations in this study, including a variety of outcomes 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 have residual symptoms after treatment and are characterized by a higher risk of relapse, and therefore may benefit from treatment much less than patients without childhood trauma in the long term. . The study design did not take into account differences between the sexes.
Antoine Erondi, from the University of Toulouse in France (who was not involved in the research), said in an associated comment, “This meta-analysis could allow to deliver a hopeful message to patients with childhood trauma that evidence-based psychotherapy and pharmacotherapy can improve symptoms of Depression.
“However, clinicians should keep in mind that childhood trauma can be associated with clinical features that may make it more difficult to reach full symptom remission, and thus have an impact on daily functioning.”
About this research on depression and child abuse news
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“Treatment efficacy and efficacy in adults with major depressive disorder and a history of childhood trauma: a systematic review and meta-analysisWritten by Erica Kuzminskate et al. Lancet Psychiatry
Treatment efficacy and efficacy in adults with major depressive disorder and a history of childhood trauma: a systematic review and meta-analysis
Childhood trauma is a common and strong risk factor for major depressive disorder in adulthood, which is associated with earlier onset, chronic or recurrent symptoms, and a higher likelihood of developing comorbidities. Some studies suggest that evidence-based pharmacological and psychological therapies 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 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 unfavorable treatment outcomes after active treatment, and were less likely to To benefit from effective treatment. Treatments related to a 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 21 November 2013 to 16 March 2020 with the full text of selected randomized clinical trials (RCTs) from multiple sources (1966 through 2016-19) to identify articles in English. Randomized controlled trials and open trials comparing the efficacy or efficacy of evidence-based pharmacotherapy, psychotherapy, or a combination intervention for adult patients with depressive disorders and the presence or absence of childhood trauma were included. Two independent researchers extracted study characteristics. Group data for effect size calculations were requested from the study authors. The primary outcome was a change in depression severity from baseline to the end of the acute treatment phase, expressed as standard effect size (Hedges’ g). Meta-analyses were performed using random effects models.
Of the 10,505 publications, 54 trials met the inclusion criteria, of which 29 (20 randomized controlled trials and nine open trials) contributed data to a maximum of 6,830 participants (age range 18–85 years, male and female individuals and ethnicity-specific data not available). More than half (4,268 [62%] Of the 6,830) patients with major depressive disorder reported a history of childhood trauma. Although more severe depression was present at baseline (g = 0 202, 95% CI 0 145 to 0 258, I2= 0%), patients with childhood trauma benefited from effective treatment similarly to patients without a history of childhood trauma (treatment effect difference between groups g = 0 016, -0 094 to 0 125, I2= 44 3%), with no significant differences in the effects of active treatment (against control condition) among individuals with or without childhood trauma (childhood trauma g = 0 605, 0 294 to 0 916, I2= 58 0%; no childhood traumas g = 0 178, -0 195 to 0 552, I2= 67 5%; Difference between group p = 0 051), and similar drop-out rates (risk ratio 1 063, 0 945 to 1 195, I2= 0%). Outcomes did not differ significantly by type of childhood trauma, study design, depression diagnosis, method of assessment of childhood trauma, study quality, year, type or length of treatment, but did differ by country (North American studies showed greater 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%] than 29), but sensitivity analysis in the low-bias studies yielded similar results when all studies were included.
In contrast to previous studies, we found evidence that the symptoms of patients with major depressive disorder and childhood trauma improve significantly after drug and psychotherapy treatments, despite the severity of their depressive symptoms. Evidence-based psychotherapy and pharmacological treatment should be offered to patients with major depressive disorder regardless of their childhood trauma status.