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Childhood maltreatment influences relapse risk in major depression

Analysis indicated that childhood maltreatment may lead to changes in brain structure that in turn increase the risk for future relapse in patients with major depression.

In addition, reduced cortical surface area — mainly in the insula — mediated the association between childhood maltreatment and recurrent depression, according to data published in The Lancet Psychiatry.

Prior research has demonstrated that both childhood maltreatment and MDD are independently associated with brain structural alterations in regions implicated in emotion regulation, according to Nils Opel, MD, from the department of psychiatry, University of Münster, Germany, and colleagues.

“[This] appears highly suggestive for a mediating role of brain structural changes in the relationship between early life stress and depressive phenotype,” they wrote. “Despite these intriguing findings from cross-sectional research, no longitudinal studies are available that confirm this hypothesis.”

To better understand the connection between early life trauma, brain structural alterations and depression relapse, researchers examined patients with 2-year clinical data, baseline MRI and Childhood Trauma Questionnaire data. The investigators conducted clinical assessments using structured interviews based on DSM-IV criteria at baseline and at follow-up 2 years after initial recruitment. Participants were stratified based on their relapse status.

In total, 110 patients had major depressive disorder; 35 were relapse-free and 75 had experienced depression relapse within the 2-year follow-up period.

Analysis revealed a connection between childhood maltreatment and relapse during follow-up (OR = 1.035; 95% CI, 1.001-1.07). Furthermore, past early life maltreatment and future depression relapse were linked to decreased cortical surface area (OR = 0.996; 95% CI, 0.994-0.999) — mainly in the right insula (r = 0.219; P = .023) — at baseline.

Mediation analysis yielded a connection between childhood trauma and insular surface area (coefficient = –3.66; 95% CI, –6.82 to –0.5) as well as a connection between insular surface area and relapse (coefficient = –0.0035; 95% CI, –0.0058 to –0.0012). The model also indicated that insular surface area mediated the link between maltreatment and subsequent depression relapse (indirect effect: coefficient = 0.0128; 95% CI, 0.0024-0.0333).

“Considering the relevance of the insular cortex for cognitive domains such as interoceptive and emotional awareness, it is possible that the observed brain structural changes decrease the likelihood of response to conventional therapeutic strategies in maltreated patients with major depressive disorder,” Opel and colleagues wrote. “To this end, future translational psychiatric research should explore the functional and clinical relevance of the presented findings.”

Disclosure: The authors report no relevant financial disclosures.