Childhood Trauma Not a Barrier to Successful Depression Treatment, Analysis Finds

Although previous research has suggested that a history of childhood trauma has been linked with a worse response to treatment for major depressive disorder (MDD) in adulthood, a large meta-analysis published Thursday found that is not the case.

Regardless of childhood trauma history, psychotherapy and drug therapy should be offered to all patients with MDD, the analysis said. The study was published in The Lancet Psychiatry.

The authors said the previous studies were not definitive and that some meta-analytic studies showed “high between-study heterogeneity, and some primary studies report similar or even better improvement for patients with childhood trauma than for those without” after psychotherapy or pharmacotherapy.

Childhood trauma—emotional/physical neglect or emotional/physical/sexual abuse before the age of 18—is a risk factor for the development of MDD in adulthood. MDD in these cases may produce symptoms earlier, create cycles of illness that last longer and happen more frequently, and have a higher risk of morbidity.

In addition, a previous analysis found that adults and adolescents with depression and childhood trauma were around 1.5 times more likely to not respond or have remission from MDD compared with those without childhood trauma.

The review searched 3 databases for randomized clinical trials published between November 21, 2013, and March 16, 2020. From an initial list of 10,505 publications, 54 trials were initially included, and 29 studies were analyzed.

Most of the clinical trials (51.7%) were conducted in Europe, followed by North America (31%). Most of the studies focused on MDD (59%) with the rest on chronic or treatment-resistant depression (38%). Most of the studies had a high risk of bias.

Of the 6830 participants (age range, 18-85 years; specific sex and ethnicity data unavailable), 62% had MDD and a history of childhood trauma. Although these patients had more severe depression at baseline, they benefitted from active treatment similarly to patients who did not have the experience of childhood trauma (treatment effect difference between groups g = 0.016; –0.094 to 0.125; I² = 44.3%).

The authors noted that the rate of childhood trauma in this analysis was higher than the 46% found in a previous meta-analysis, and said one reason might be because there were a high number of studies included that focused on chronic or treatment-resistant depression; those patients have a childhood trauma rate of about 75%.

In this analysis, the most common type of trauma was, in order, emotional neglect and emotional abuse, followed by physical abuse, physical neglect, and sexual abuse.

Patients with trauma reported more depressive symptoms at both the start and end of the treatment, but childhood trauma did not affect the efficacy of depression treatment, influence the success of treatment type, or the rate of ending therapy.

In addition, findings 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.

The study had some limitations, including a high variety of results among the studies included in the meta-analysis, all cases of childhood trauma being reported retrospectively, and no accounting for differences between genders. In addition, this population has a high risk of relapse and “may benefit from treatment significantly less than patients without childhood trauma in the long run,” the authors wrote.

In a related commentary, a psychiatrist who was not involved in the research pointed out several reasons why the results should be interpreted with caution, although he called them encouraging.

It is now well-known that childhood trauma is linked to anxiety disorder, posttraumatic stress disorder, substance use disorder, as well as obesity, diabetes, and cardiovascular disease in adulthood, wrote Antoine Yrondi, MD, PhD, a psychiatrist at the University of Toulouse, France. “The association could be, at least partially, caused by epigenetic mechanisms. These comorbidities could make major depressive disorder more difficult to diagnose and to treat.”

In addition, sleep complaints, particularly insomnia, could affect MDD symptoms, he noted.

The study did not compare remission rates of MDD between those with childhood trauma and those without, and since those with a trauma history may have more persistent symptoms, they may need more focused attention from providers, he said.

More research is needed on the effects of childhood trauma in MDD and related issues, and “it is important that physicians are trained to evaluate childhood trauma and to take it into account in their daily practice,” Yrondi concluded.