Treatment significantly improved symptoms in those with MDD, childhood trauma

In individuals with major depressive disorder and childhood trauma, symptoms improved significantly following pharmacological and psychotherapeutic treatments, regardless of severity, per a study published in Lancet Psychiatry.

“In patients with a history of childhood trauma, depressive disorders, including major depressive disorder, are characterized by earlier onset, greater recurrence, more comorbidity and poorer responses to psychotherapy or pharmacotherapy,” Erika Kuzminskaite, MS, a PhD candidate in the department of psychiatry at Vrije University in the Netherlands, and colleagues wrote.

Kuzminskaite and fellow researchers in the Childhood Trauma Meta-Analysis Group examined whether individuals with major depressive disorder — including chronic forms of depression, and a reported history of childhood trauma — had more severe symptoms before treatment, more unfavorable treatment outcomes following active treatments, and were less likely to benefit from active treatments relative to a control condition, compared with individuals with depression without childhood trauma.

They performed a meta-analysis, searching PubMed, PsycINFO and Embase from November 2013 to March 2020, as well as full-text randomized clinical trials (RCTs) identified from several sources (1966 up to 2016–2019) to identify articles in English. From a total of 10,505 publications, 54 trials met inclusion criteria, of which 29 (20 RCTs and nine open trials) contributed data of a maximum of 6,830 participants aged 18 to 85 years. Primary outcome for the analysis was depression severity change from baseline to the end of acute treatment phase, expressed as standardized effect size. Meta-analyses were performed via random-effects models.

Results showed that 4,268 of 6,830 of patients with major depressive disorder reported a history of childhood trauma. Despite having more severe depression at baseline (0.202; 95% CI, 0.145 to 0.258), patients with childhood trauma benefited from active treatment similarly to patients without childhood trauma history (treatment effect difference between groups, 0.016; 95% CI, –0.094 to 0.125), with no significant difference in active treatment effects (vs. control condition) between individuals with and without childhood trauma (childhood trauma, 0.605; 95% CI, 0.294 to 0.916; no childhood trauma; 0.178; 95% CI, –0.195 to 0.552), and similar dropout rates (RR, 1.063; 95% CI, 0.945 to 1.195).

The researchers also found that data did not significantly differ by childhood trauma type, study design, depression diagnosis, assessment method of childhood trauma, study quality, year, or treatment type or length, but differed by country.

“To improve interventions and outcomes for individuals with childhood trauma,” Kuzminskaite and colleagues wrote, “comprehensive and collaborative research is necessary to examine long-term treatment outcomes, residual symptoms after treatment, and mechanisms through which childhood trauma exerts its long-lasting effects.”