Adults with a history of childhood trauma may benefit from recommended depression treatment, contrary to current theory

summary: Patients with major depressive disorder who have experienced trauma in childhood appear to improve symptoms after psychotherapeutic 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 combination treatment.

Results of a new study published in The Lancet Psychiatrysuggest that contrary to current theory, these general 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 the age of 18) is known to be a risk factor for the development of major depressive disorder in adulthood, often causing such symptoms. Symptoms that start earlier, are longer lasting/recur more frequently, and with increased risk of morbidity.

Previous studies have suggested that adults and adolescents with depression and childhood trauma were approximately 1.5 times more likely to respond or not respond after pharmacotherapy, psychotherapy, or combination treatment than those with childhood trauma.

“This study is the largest of its kind to look at the effectiveness of depression treatment for adults with childhood trauma and to compare the effect of active treatment with a control condition (waitlist, placebo, or care-as-usual). The first is also this population.

“About 46% of adults with depression have a history of childhood trauma, and the prevalence is even higher for chronic depression sufferers. It is therefore important to determine whether current treatments are offered for major depressive disorder in childhood.” are effective for patients with trauma,” says the Ph.D. candidate and the study’s first author, Erica Kuzminskite.

Researchers used data from 29 clinical trials of pharmacotherapy and psychotherapeutic treatment for major depressive disorder in adults, involving a maximum of 6,830 patients. Of the participants, 4,268 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%). 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: were childhood trauma patients more severely depressed before treatment, were there more adverse outcomes after active treatment for patients with childhood trauma, and whether childhood trauma patients were more severely depressed than controls. Benefit from active treatment was less likely than from the condition. ,

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

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

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

“The finding that patients with depression and childhood trauma experience similar treatment outcomes compared to patients without trauma may give hope to those who experienced childhood trauma. Nevertheless, childhood trauma Patients with residual symptoms after treatment receive more clinical attention because additional intervention may still be needed.

Erica Kuzminskite says, “Future research is necessary to examine long-term treatment outcomes and mechanisms through which childhood trauma can affect its outcomes in order to provide more meaningful advances and improve outcomes for individuals with childhood trauma.” long-term impact.”

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Previous studies have suggested that adults and adolescents with depression and childhood trauma were approximately 1.5 times more likely to respond or not respond after pharmacotherapy, psychotherapy, or combination treatment than those with childhood trauma. Image is in public domain

The authors acknowledge some limitations with this study, including the high type of results among the studies included in the meta-analysis, and all cases of childhood trauma being reported retrospectively.

The meta-analysis focused on a decline in symptoms during the acute treatment phase, but people with depression and childhood trauma often show residual symptoms after treatment and are characterized by a high risk of recurrence, thus they are less likely to develop symptoms during childhood. Patients may benefit significantly less from treatment than patients without trauma. in the long run. Differences between genders were also not accounted for in the study design.

Writing in a linked comment, Antoine Yorandi, University of Toulouse, France (who was not involved in the research) said, “This meta-analysis may allow patients with childhood trauma to deliver an optimistic message that is based on evidence-based psychotherapy. And pharmacotherapy can improve depressive symptoms.

“However, clinicians should keep in mind that childhood trauma may be associated with clinical features that may make it more difficult to reach full symptomatic remission, and therefore, have an impact on daily functioning.”

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Research news about this depression and child abuse

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

Basic Research: closed access.
,Treatment efficacy and effectiveness in adults with a history of major depressive disorder and childhood trauma: a systematic review and meta-analysis“By Erica Kuzminskite et al. lancet psychiatry


essence

Treatment efficacy and effectiveness in adults with a history of major depressive disorder and childhood trauma: a systematic review and meta-analysis

background

Childhood trauma is a common and powerful risk factor for developing major depressive disorder in adulthood, associated with earlier onset, more chronic or recurrent symptoms, and a greater likelihood of comorbidities. Some studies indicate that evidence-based pharmacotherapy and psychotherapy for adult depression may be less efficacious in patients with a history of childhood trauma than in patients without childhood trauma, but findings are inconsistent. Therefore, we investigated 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, with more adverse treatment outcomes after active treatment. The results were there, and less likely to benefit from active. Treatment relative to the control condition compared to individuals with depression without childhood trauma.

methods

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

test result

From 10 505 publications, 54 trials met the inclusion criteria, of which 29 (20 RCTs and nine open trials) used data from a maximum of 6830 participants (age range 18–85 years, male and female individuals and specific ethnicity data unavailable). has contributed. more than half (4268.) [62%] 6830 of the 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, I2= 0%), patients with childhood trauma benefited from the same active treatment as patients without a history of childhood trauma (group G = 0 016, treatment effect difference between -0 094 to 0 125, I2=44 3%), with no significant difference in active treatment effects (Vs control condition) between individuals with and without childhood trauma (childhood trauma g=0 605, 0 294 to 0 916, I2=58 0%; no childhood trauma g=0 178, -0 195 to 0 552 I2=675%; between-group difference p=0 051), and similar dropout rates (risk ratio 1 063, 0 945 to 1 195, I2= 0%). Findings did not differ significantly by type or length of childhood trauma, study design, depression diagnosis, assessment method of childhood trauma, study quality, year, or type or length of treatment, but did differ by country (answers). US studies showed large treatment effects for patients with childhood trauma (corrected mis-discovery rate p=0 0080). Most studies had a moderate to high risk of bias (21 [72%] 29), but sensitivity analysis in low-bias studies yielded similar conclusions as for all studies included.

Explanation

In contrast to previous studies, we found that the symptoms of patients with major depressive disorder and childhood trauma significantly improved after pharmacological and psychotherapeutic treatment, irrespective of their high severity of depressive symptoms. Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder regardless of childhood trauma status.

Grant

none.

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