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Adults With a History of Childhood Trauma Can Benefit From Recommended Depression Treatments, Contrary to Current Theory


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

Source: 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 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 leading to earlier onset and longer lasting symptoms. more frequently recurring and with an increased risk of morbidity.

Previous research has shown that adults and adolescents with depression and childhood trauma are about 1.5 times more likely to fail to respond to pharmacotherapy, psychotherapy, or combination therapy than those without childhood trauma.

“This study is the largest of its kind examining the efficacy of treatment for depression in adults with childhood trauma, and also the first to compare the effect of active treatment with a control condition (waiting list, placebo, or usual care) for this population.

“About 46% of adults with depression have a history of childhood trauma, and the prevalence is even higher in those with chronic depression. Therefore, it is important to determine whether current therapies for major depressive disorder are effective for patients with childhood trauma,” says Ph.D. Candidate and first author of the study, Erika Kuzminskaite.

The investigators used data from 29 clinical trials of pharmacotherapy and psychotherapy for major depressive disorder in adults, enrolling no more than 6830 patients. Of the participants, 4268, or 62.5%, reported 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 Depression Rating Scale (HRSD).

Three research questions were tested: were childhood trauma patients more severely depressed before treatment, were there more adverse outcomes after active treatment of childhood trauma patients, and were children with trauma patients less likely to benefit from active treatment than controls.

Consistent with previous studies, patients with childhood trauma had more severe symptoms at the start of treatment than patients without childhood trauma, highlighting the importance of taking symptom severity into account when calculating treatment effects.

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

Treatment discontinuation rates were also similar for patients with and without childhood trauma. Measured treatment efficacy was independent of type of childhood trauma, diagnosis of depression, method of assessing childhood trauma, study quality, year, type of treatment, or duration.

“Finding that patients with depression and childhood trauma experience the same treatment outcome compared to patients without trauma may offer hope to people who have experienced childhood trauma. However, post-treatment residual symptoms in pediatric trauma patients require more clinical attention as additional interventions may still be required.

“To ensure further meaningful progress and improve outcomes for people with childhood trauma, future research is needed to explore long-term treatment outcomes and the mechanisms by which childhood trauma exerts its long-term impact,” says Erika Kuzminskaite.

It shows a sad child
Previous research has shown that adults and adolescents with depression and childhood trauma are about 1.5 times more likely to fail to respond to pharmacotherapy, psychotherapy, or combination therapy than those without childhood trauma. The image is in the public domain

The authors acknowledge some limitations of this study, including the high diversity of results among the studies included in the meta-analysis and the retrospective reporting of all cases of childhood trauma.

The meta-analysis focused on symptom relief during the acute phase of treatment, but people with depression and childhood trauma often have residual symptoms after treatment and are at high risk of relapse, so they may benefit significantly less from treatment than patients without childhood trauma. injury. in the long run. The study design also did not take into account differences between the sexes.

In a related comment, Antoine Irondy of the University of Toulouse, France (who was not involved in the study) said: “This meta-analysis may provide an encouraging message to childhood trauma patients that evidence-based psychotherapy and pharmacotherapy can improve depressive symptoms.

“However, physicians should be aware that childhood trauma may be associated with clinical manifestations that may make it difficult to achieve complete symptomatic remission and therefore affect daily activities.”

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About this Depression and Child Abuse Research News

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

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


Abstract

Efficacy and effectiveness of treatment for adults with major depressive disorder and childhood trauma: a systematic review and meta-analysis

Background

Childhood trauma is a common and powerful risk factor for the development of major depressive disorder in adulthood, associated with earlier onset, more chronic or recurrent symptoms, and a greater likelihood of comorbidities. Some studies suggest that evidence-based pharmacotherapy and psychotherapy 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 adverse treatment outcomes after active treatment, and were less likely to benefit from active treatment. treatment compared to controls compared to people with depression without childhood trauma.

Methods

We performed a comprehensive meta-analysis (PROSPERO CRD42020220139). Study selection combined searches of bibliographic databases (PubMed, PsycINFO and Embase) from November 21, 2013 to March 16, 2020 and full-text randomized clinical trials (RCTs) obtained from multiple sources (from 1966 to 2016-2019) . identify articles in English. RCTs and open trials comparing the efficacy or efficacy of evidence-based pharmacotherapy, psychotherapy, or combination interventions in 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 the change in severity of depression from baseline through the end of the acute phase of treatment, expressed as a standardized effect size (g Hedges). Meta-analysis was conducted using random effects models.

results

Of the 10,505 publications, 54 trials met the inclusion criteria, of which 29 (20 RCTs and nine open-label trials) provided data for a maximum number of participants of 6830 (age range 18–85, male and female, no data on specific ethnicity). More than half (4268 [62%] of 6830) 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, I2=0%), patients with childhood trauma benefited from active treatment in the same way as patients without a history of childhood trauma (difference in treatment effect between groups g=0.016, from -0.094 to 0.125, I2=44 3%), with no significant difference in the effects of active treatment (against control state) between people with and without childhood trauma (childhood trauma g=0.605, from 0.294 to 0.916, I2=58 0%; no childhood trauma g=0.178, from –0.195 to 0.552, I2=67 5%; difference between groups p=0.051) and similar dropout rates (risk ratio 1.063, 0.945 to 1.195, I2=0%). Outcomes did not differ significantly by type of childhood trauma, study design, diagnosis of depression, method of assessing childhood trauma, study quality, year, type of treatment, or duration, but differed across countries (North American studies showed greater treatment effect in patients with childhood trauma). ; false discovery rate adjusted p=0 0080). In most studies, the risk of bias was moderate to high (21 [72%] of 29), but sensitivity analyzes in studies with low bias yielded the same results as when 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 treatment, despite more severe symptoms of depression. Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder, regardless of childhood trauma status.

Financing

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