Childhood trauma is not a barrier to successful depression treatment, according to analysis

Although previous research has indicated that a history of childhood trauma has been associated with a worse response to treatment severe depressive disorder (MDD) In ​​adulthood, a large meta-analysis published Thursday found that this is not the case.

The analysis said, regardless of history of childhood trauma, all patients with MDD should be offered psychotherapy and pharmacotherapy. The study was published in Lancet Psychiatry.

The authors said that previous studies were not definitive and that some meta-analytic studies showed “high between-study heterogeneity, and some preliminary studies report similar or even better improvement for patients with childhood trauma compared to those without” after psychotherapy or pharmacotherapy.

Childhood trauma–emotional/physical neglect or emotional/physical/sexual abuse before age 18–is a risk factor for developing MDD in adulthood. Major depressive disorder in these cases may cause symptoms earlier, resulting in cycles of disease that last longer and occur more frequently, and are more prone to illness.

In addition, a previous analysis found that adults and adolescents with depression and childhood trauma were about 1.5 times more likely to have no response or remission from major depressive disorder than those without childhood trauma.

The review searched 3 databases of randomized clinical trials published between 21 November 2013 and 16 March 2020. From the initial list of 10,505 publications, 54 trials were initially included, and 29 studies were analysed.

Most clinical trials (51.7%) were conducted in Europe, followed by North America (31%). Most studies focused on MDD (59%) and the rest on chronic or treatment-resistant depression (38%). Most studies had a high risk of bias.

Of the 6,830 participants (age range, 18–85 years; specific sex and ethnicity data not available), 62% had MDD and had a history of childhood trauma. Although these patients had more severe depression at baseline, they benefited from active treatment similar to patients without childhood trauma (treatment effect difference between groups g = 0.016; -0.094 to 0.125; I² = 44.3%).

The authors note that the rate of childhood trauma in this analysis was higher than the 46% found in a previous meta-analysis, and they said one reason may be due to the large number of studies focusing on chronic or treatment-resistant depression. ; These patients have a childhood trauma rate of about 75%.

In this analysis, the most common type of trauma, in order, was emotional neglect and emotional abuse, followed by physical abuse, physical neglect, and sexual abuse.

Traumatized patients reported more depressive symptoms at the beginning and end of treatment, but childhood trauma did not affect depression treatment efficacy or affect the success of treatment type or treatment termination rate.

In addition, 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.

The study had some limitations, including a variety of outcomes among the studies included in the meta-analysis, all cases of childhood trauma were reported retrospectively, and no accounting for gender differences. In addition, this population group has a high risk of relapse and “may benefit from treatment significantly less than patients without long-term childhood trauma,” the authors wrote.

In a related comment, a psychiatrist who was not involved in the research cited several reasons for interpreting the results with caution, though he called them encouraging.

Childhood trauma is now known to be associated with anxiety disorder, PTSD, and substance use disorder, as well as obesity, diabetes, and cardiovascular disease in adulthood, writes Antoine Irondi, MD, PhD, psychiatrist at the University of Toulouse, France. . The association could be, at least in part, due to epigenetic mechanisms of inheritance. These comorbidities can make it more difficult to diagnose and treat major depressive disorder.”

In addition, sleep complaints, especially insomnia, can influence symptoms of major depressive disorder.

He said the study did not compare rates of MDD remission between those with and without childhood trauma, and since those with a history of trauma may have more persistent symptoms, they may need more focused attention from providers.

More research is needed on the effects of childhood trauma in major depressive disorder (MDD) and related issues, and Yorundi concluded that “it is important that clinicians are trained to assess childhood trauma and take it into account in their daily practice.”