Treatment Works for Depression After Childhood Trauma

While patients with major depressive disorder and childhood trauma had more severe depressive symptoms, they benefited from treatment as much as those without childhood trauma, a meta-analysis found.

A history of childhood trauma was associated with more severe depression at baseline, with a Hedges’ g of 0.202 reflecting a small but significant effect size, reported Erika Kuzminskaite, a PhD candidate at Vrije University in Amsterdam, and colleagues, writing in The Lancet Psychiatry.

However, the magnitude of benefit from active treatment came out similar regardless of childhood trauma (treatment difference between groups g=0.016, 95% CI -0.094 to 0.125), as did the effect relative to controls (between group difference P=0.051).

Findings also did not significantly differ by childhood trauma type, study design, depression diagnosis, assessment methods for childhood trauma, study quality, years, or treatment type. However, it did differ by country, with North American studies showing larger treatment effects for patients with childhood trauma (false discover rate corrected P=0.0080).

“Evidence-based psychotherapy and pharmacotherapy should be offered to depressed patients regardless of childhood trauma status,” Kuzminskaite said to MedPage Today. “Screening for childhood trauma is important to identify individuals at risk for more severe course of the disorder and post-treatment residual symptoms.”

Childhood trauma — emotional or physical neglect, or emotional, physical, or sexual abuse — is common and is an important risk factor for major depressive disorder later in life, the authors noted. The authors cautioned that childhood trauma is associated with earlier onset, more chronic symptoms, and greater probability of having comorbidities.

“This meta-analysis delivers a hopeful message to patients with childhood trauma,” Antoine Yrondi, MD, PhD, of Université de Toulouse in Toulouse, France, wrote in an accompanying editorial. “Even if childhood trauma is not modifiable, its consequences could be.”

However, a point for clinicians to keep in mind, Yrondi noted, is that clinical features of early trauma patients might make it more difficult to reach complete symptomatic remission and thus continue to impact daily functioning.

“Treatment for those with a history of childhood trauma could include a precision medicine approach in major depressive disorder,” Yrondi continued. “Future research should focus on the effects of childhood trauma on clinical features such as sleep complaints and disorders in people with major depressive disorder and, more specifically, with difficult-to-treat depression.”

This comprehensive meta-analysis was conducted using studies from 1966 up to 2019 that investigated evidence-based effectiveness of pharmacotherapy and psychotherapy interventions in adult patients with or without childhood trauma. The primary outcome was defined as change in depression severity from baseline to the end of the acute treatment phase.

Studies included focused on patients with depression as a primary diagnosis who had childhood trauma assessment. The studies looked at psychotherapy or pharmacotherapy for depression along with a comparator group, with clinician- or self-reported depression severity determined before and after the acute treatment phase.

The 29 studies included in the meta-analysis had a total of 6,830 participants. Ages ranged from 18-85 years, but data on sex and ethnicity were not available. Fully 62% of major depressive disorder patients reported a history of childhood trauma. The most common childhood trauma types were emotional neglect (58%) and emotional abuse (52%).

Limitations of the study included moderate to high statistical heterogeneity across the studies. In addition, gender-specific effects or controls for potential confounders were not examined. Not all study authors could contribute patient data, leading to an increased likelihood of selection bias.

Most studies (21 of the 29 included) did have a moderate to high risk of bias, but low-bias studies yielded similar results.

Furthermore, the researchers focused on symptom decline during the acute treatment phase, but patients with depression and childhood trauma often show residual symptoms after treatment. Finally, childhood trauma was reported retrospectively, which might limit generalizability.