Overview: Psychopharmacological interventions, psychotherapy, or a combination of both improve symptoms in people with major depressive disorder who experienced childhood trauma.
sauce: lancet
Adults with major depressive disorder who have a history of childhood trauma experience symptom improvement after pharmacological, psychological, or combination therapy.
Results of a new study published in lancet psychiatrysuggest that, contrary to current theory, these common treatments for major depressive disorder are effective in childhood trauma patients.
Childhood trauma (defined as emotional/physical neglect or emotional/physical/sexual abuse before age 18) is a known risk factor for developing major depressive disorder in adulthood. often with early onset and long-lasting/persistent symptoms. It recurs more frequently, increasing the risk of morbidity.
Previous studies have shown that adults and adolescents with depression and childhood trauma are approximately more likely than those without childhood trauma to respond or go into remission after pharmacological, psychological, or combination therapy. suggested to be 1.5 times higher.
“This study is the largest study of its kind to examine the effectiveness of treatment for depression in adults with childhood trauma, and the effect of active treatment was measured in control conditions (wait list, placebo, or It is also the first study to compare it with usual care) in this population.
“Approximately 46% of adults with depression experienced childhood trauma, and the prevalence of those with chronic depression is even higher. “It is important to determine whether current therapies are effective for childhood trauma patients,” he said. Erica Kuzminskayte, candidate and lead author of the study.
The researchers used data from 29 clinical trials of pharmacological and psychotherapeutic treatments for adult major depressive disorder involving up to 6,830 patients. Her 4,268 or 62.5% of participants 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 was determined using the Beck Depression Inventory (BDI) or the Hamilton Rating Scale for Depression (HRSD).
The three study questions tested were whether childhood trauma patients had more severe depression before treatment, whether childhood trauma patients had more unfavorable outcomes after aggressive treatment, and whether childhood trauma patients had more unfavorable outcomes after aggressive treatment. was less likely to benefit from aggressive treatment than the control condition.
Consistent with results from previous studies, patients with childhood trauma had higher symptom severity at the start of treatment than patients without childhood trauma, suggesting that symptom severity emphasizes the importance of considering
Childhood trauma patients reported more depressive symptoms both at the beginning and end of treatment, but experienced similar symptom improvements compared with patients without a history of childhood trauma. .
Treatment dropout rates were also similar in patients with and without childhood trauma. Measured treatment effects did not vary by type of childhood trauma, diagnosis of depression, method of assessing childhood trauma, quality of study, year, type or duration of treatment.
“Finding that patients with depression and childhood trauma experience similar treatment outcomes compared to those without trauma gives hope to those who have experienced childhood trauma. Nonetheless, post-treatment residual symptoms in childhood trauma patients require more clinical attention as they may still require additional interventions.
Erica Kuzminskite said, “In order to bring about more meaningful progress and improve outcomes for individuals with childhood trauma, we will explore the long-term treatment outcomes and the mechanisms by which childhood trauma has long-term effects. Future studies are needed to examine the
The authors acknowledge that this study has some limitations. For example, the studies included in the meta-analysis included mixed results and retrospectively reported all cases of childhood trauma.
Meta-analyses have focused on symptom reduction during the acute treatment phase, but people with depression and childhood trauma often exhibit residual symptoms after treatment and are characterized by a higher risk of relapse. As such, patients with childhood trauma may benefit significantly less from treatment in the long run than patients without trauma. Gender differences were also not considered in the study design.
Antoine Yrondi of the University of Toulouse, France (not involved in the research) wrote in the linked comments: Improve depressive symptoms.
“However, physicians believe that childhood trauma may be associated with clinical features that may make it more difficult to reach complete remission of symptoms, thus impacting daily life.” We have to keep in mind that there is a
See also
About this Depression and Child Abuse Research News
author: press office
sauce: lancet
contact: Press Office – The Lancet
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Original research: closed access.
“Effectiveness and efficacy of treatment in adults with major depressive disorder and a history of childhood trauma: a systematic review and meta-analysis.Erica Kuzminskayte and others Lancet Psychiatry
Overview
Effectiveness and efficacy of treatment in adults with major depressive disorder and a history of childhood trauma: a systematic review and meta-analysis.
Background
Childhood trauma is a common and strong risk factor for developing major depressive disorder in adulthood, and is associated with earlier onset, more chronic or recurrent symptoms, and a higher likelihood of comorbidities. I’m here. Several studies have shown that evidence-based drug and psychotherapy for depression in adults may be less effective in patients with a history of childhood trauma than in those without childhood trauma. but the findings are inconsistent. We therefore found that individuals with major depressive disorder, including chronic forms of depression, and a reported history of childhood trauma had more severe depressive symptoms before treatment or more after active treatment. We examined whether patients with depression without childhood trauma had an adverse treatment outcome or were less likely to benefit from active treatment compared to a control condition.
method
A comprehensive meta-analysis was performed (PROSPERO CRD42020220139). The selection of studies was based on searches of bibliographic databases (PubMed, PsycINFO, and Embase) from 21 November 2013 to 16 March 2020 and from several sources (1966 to 2016–19). It combines the full text of identified randomized clinical trials (RCTs). Identifies articles in English. We included RCTs and open-label trials comparing the efficacy or efficacy of evidence-based pharmacological, psychological, or combination interventions for adult patients with depressive disorders, and childhood trauma with or without trauma. Two independent researchers extracted study features. Group data for effect size calculation were requested by the study authors. The primary outcome was the change in depression severity from baseline to the end of the acute treatment phase, expressed as a standardized effect size (Hedges’ g). A meta-analysis was performed using a random-effects model.
findings
From 10,505 publications, 54 trials met the inclusion criteria, 29 of which (20 RCTs and 9 open trials) contributed data from up to 6830 participants (age range of 18 age ~85, male and female individuals, and specific ethnicity data not available). more than half (4268 [62%] 6830 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, Me2=0%), patients with a history of childhood trauma benefited from aggressive treatment as did patients without a history of childhood trauma (difference in treatment effect between groups g=0.016, –0.094 from 0.125, Me2=44 3%), no significant difference in the active treatment effect (versus control condition) with or without childhood trauma (childhood trauma g = 0.605, 0.294 to 0.916; Me2=58 0%; no childhood trauma g=0.178, –0.195 to 0.552, Me2=67 5%; between-group difference p=0.051), and similar dropout rates (risk ratios 1.063, 0.945–1.195, Me2= 0%). Findings did not differ significantly by type of childhood trauma, study design, diagnosis of depression, method of assessing childhood trauma, study quality, year, or type or duration of treatment, but by country. different (North American study showed greater therapeutic effect in childhood trauma patients; false discovery rate corrected p=0 0080). Most studies were at moderate to high risk of bias (21 [72%] of 29), but sensitivity analyzes of low-biased studies yielded similar results when all studies were included.
interpretation
In contrast to previous studies, symptoms in patients with major depressive disorder and childhood trauma improve significantly after pharmacological and psychotherapeutic treatment, despite greater severity of depressive symptoms evidence was found. Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder, regardless of childhood traumatic status.
fundraising
none.
