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.

the findings

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.


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