Depression and Childhood Trauma

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 Depression and Childhood Trauma

 Jim Windell

            Many people have experienced childhood trauma – whether that trauma is due to emotional or physical neglect or emotional, physical, or sexual abuse. Trauma that occurred in childhood has been found to be a significant risk factor for major depressive disorder later in life. In fact, around 46% of adults with depression have a history of childhood trauma,

           Furthermore, having experienced childhood trauma often results in earlier onset symptoms that last longer, happen more frequently, and occur with an increased risk of morbidity. Some studies have suggested that adults and adolescents with depression and childhood trauma were around 1.5 times more likely to fail to respond to pharmacotherapy, psychotherapy, or a combination of those two treatments, than those without childhood trauma.
            A new study, however, takes issue with these previous indications. The impetus for the study was the belief that it is important to determine whether current treatments offered for major depressive disorder are effective for patients with childhood trauma.  

           Writing recently in The Lancet Psychiatry, a research team reports that their study is the largest of its kind to look at the effectiveness of depression treatments for adults with childhood trauma. Also, it is the first research project to compare the effect of active treatment with control condition (waitlist, placebo, or care-as-usual) for this population.

           The researchers, led by Ph.D. candidate and first author of the study, Erika Kuzminskaite, used data from 29 clinical trials of pharmacotherapy and psychotherapy treatments for major depressive disorder in adults, covering 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%). Depression severity measures were determined using the Beck Depression Inventory (BDI) or Hamilton Rating Scale for Depression (HRSD).

           The three research questions tested were 1.) whether childhood trauma patients were more severely depressed prior to treatment; 2.) whether there were more unfavorable outcomes following active treatments for patients with childhood trauma; and 3.) whether childhood trauma patients were less likely to benefit from active treatment than control condition.

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

           Although childhood trauma patients reported more depressive symptoms at both the start and end of the treatment, they experienced similar symptom improvement compared to patients without childhood trauma history. Treatment dropout rates were also similar for patients with and without childhood trauma. The measured treatment efficacy did not vary by childhood trauma type, depression diagnosis, assessment method of childhood trauma, study quality, year, treatment type or length.
           According to Erika Kuzminskaite, “Finding that patients with depression and childhood trauma experience similar treatment outcome when compared to patients without trauma can give hope to people who have experienced childhood trauma.”

           Kuzminskaite went on to say that “Nevertheless, residual symptoms following treatment in patients with childhood trauma warrant 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 mechanisms through which childhood trauma exerts its long-lasting effects.”

           So, contrary to current theory, adults with a history of childhood trauma can benefit from recommended depression treatments.

           To read the study in The Lancet Psychiatry, find it with this reference:

Kuzminskaite E, et al. (2022). Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis. Lancet Psychiatry. DOI: 10.1016/S2215-0366(22)00227-9.


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