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

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

Adults with major depressive disorder who have a history of childhood trauma experience symptom improvement after pharmacotherapy, psychotherapy, or combination treatment. The results of a new study, published in The Lancet Psychiatry, suggest that contrary to current theory, these common treatments for major depressive disorder are effective for patients with childhood trauma.
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 producing symptoms that are earlier onset, longer lasting/more frequently recurring, and with increased risk of morbidity. Previous studies have suggested that adults and adolescents with depression and childhood trauma were around 1.5 times more likely to not respond or remit after pharmacotherapy, psychotherapy, or combination treatment, than those without childhood trauma.

"This study is the largest of its kind to look at the effectiveness of depression treatments for adults with childhood trauma and is also the first to compare the effect of active treatment with control condition (waitlist, placebo, or care-as-usual) for this population. Around 46% of adults with depression have a history of childhood trauma, and for chronic depression sufferers the prevalence is even higher. It is therefore important to determine whether current treatments offered for major depressive disorder are effective for patients with childhood trauma," says Ph.D. Candidate and first author of the study, Erika Kuzminskaite.

The researchers 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: whether childhood trauma patients were more severely depressed prior to treatment, whether there were more unfavorable outcomes following active treatments for patients with childhood trauma, and 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, highlighting 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.

"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. 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," says Erika Kuzminskaite.

The authors acknowledge some limitations with this study, including a high variety of results among the studies included in the meta-analysis, and all cases of childhood trauma being reported retrospectively. The meta-analysis focused on symptom decline during acute treatment phase, but people with depression and childhood trauma often show post-treatment residual symptoms and are characterized by a high risk of relapse, thus they may benefit from treatment significantly less than patients without childhood trauma in the long run. The study design also did not account for differences between genders.

Writing in a linked Comment, Antoine Yrondi, University of Toulouse, France (who was not involved in the research) said, "This meta-analysis could allow to deliver a hopeful message to patients with childhood trauma that evidence-based psychotherapy and pharmacotherapy could improve depressive symptoms. However, physicians should keep in mind that childhood trauma could be associated with clinical features which may make it more difficult to reach complete symptomatic remission, and therefore, have an impact on the daily functioning."

More information: Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis, The Lancet Psychiatry (2022). www.thelancet.com/journals/lan … (22)00227-9/fulltext

Link: https://medicalxpress.com/news/2022-09-adults-history-childhood-trauma-benefit.html
14 replies
  1. Alireza noche
    Alireza noche says:

    In my opinion, some mental disorders can be treated with counseling and others with medication.
    Treatment with medication should be the last pass for the individual because the drug, according to its rapid function, causes more problems in other cases.
    Most of the disorders that are in adults come from their childhood, and children who are exposed to many of the cases that hurt the child’s psyche should undergo counseling, and if not followed up in adults, they become more neuropsychiatric disorders.

  2. Hannanekazemi
    Hannanekazemi says:

    This article is quite true. Unfortunately, many adults with depression disorder have a history of trauma in a child, and many neurological disorders are related to childhood and what has happened. And you can reduce the disorders by applying the treatment mentioned in this article.

  3. شیدا عباسی
    شیدا عباسی says:

    This article was very helpful, I think we should take care of our children in every way to prevent future events from causing depression.

  4. Sara ebadi
    Sara ebadi says:

    Sara ebadi
    Trauma can affect future relationships and lead to other issues such as depression and low self-esteem. This experience can also affect the way attachment is built in romantic relationships.

  5. Atiyeh soleymanian memandi
    Atiyeh soleymanian memandi says:

    I read an article that the purpose of the current research was to predict borderline personality organization traits based on childhood trauma and family emotional atmosphere in drug addicts. The result was that the results show that childhood trauma and family emotional atmosphere can The prediction of organizational traits is borderline personality

  6. Mohadeseh khan mirzaie
    Mohadeseh khan mirzaie says:

    Hello professor
    In my opinion, prevention is the most important task, conditions should be provided in educational environments to teach children how to communicate with strangers. And children can protect themselves and inform their parents quickly, even if the aggressor may be a friend or family member.

    By regard mohadeseh khan mirzaie

  7. Zahra bahram
    Zahra bahram says:

    Trauma as a very terrible experience in every person has bad consequences, especially in children, and when this child grows up, severe depression comes to him, but it is promising that it is mentioned in this article with treatment methods and psychotherapy or combined treatment in this Depressed people have improved symptoms and are not much different from depressed people who have not experienced trauma.

  8. Fateme Alijanpoor
    Fateme Alijanpoor says:

    Hello proffessor…
    Thank you for this useful article.
    I think that childhood is a very sensitive age and childrens personality is formed at this time.

  9. Khadijeh sedaghat
    Khadijeh sedaghat says:

    Considering that childhood is a very sensitive age and children’s personality is formed at that time, we as informed parents should give the necessary sex education to our children in order to deliver a healthy child to the society.
    Good luck

  10. fatemeh zare
    fatemeh zare says:

    Hello dear professor. I read the article. Due to the fact that people who had a history of trauma in childhood are one and a half times more than people who did not have a history of trauma in childhood, the possibility of recovery with medicine and treatment is less for them. Parents should familiarize their children with the conditions that cause childhood injuries and sexual and emotional abuse and try not to put their children in situations where there is a possibility of sexual and emotional injuries.

    I am Fatemeh Zare, a student at Iranian University.

  11. hamidreza taheri
    hamidreza taheri says:

    that was amazing article with a lots of informations that helps us and helps our children to have a better life sir.

  12. Mahnaz Nouruzi
    Mahnaz Nouruzi says:

    Hi dear professor
    Thanks for sharing this article
    This article was a reminder for me in terms of Freud’s psychotherapy, and it further reveals the importance of examining the past and childhood in patients with depression.However, examining childhood traumas is difficult and requires the skill of a consultant

  13. leila asghari asl
    leila asghari asl says:

    Very good, with the wish that no child will be abused emotionally, physically and sexually, and thank you for the useful information that you have provided regarding the treatment of this type of trauma.


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