Written By: Ossama Osman, MD
Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder regardless of childhood trauma status.
-Studies have shown a link of childhood trauma to increased risk for psychiatric disorders in adulthood. This include major depressive disorder which in such a case, is more likely to be associated with earlier onset, more chronic or recurrent symptoms, and greater probability of having comorbidities.
-In addition, studies also suggest that childhood trauma has broad effects on adult functioning—ranging from psychiatric status to; social, financial, educational and health functioning.
-There is a need to address challenges with respect to childhood trauma and its potential for serious mental health and adverse functional outcomes.
-Concerning treatment responsiveness, it has been controversial whether Adults with major depression who had history of child traumas are responsive to pharmacology and pharmacotherapies as much as those without history of child trauma.
A new meta-analysis provides hope in this regard.
STUDY FNDINGS:
A comprehensive meta-analysis selection combined the search of bibliographical databases from 2013, to 2020. Among 6830 adult participants in 54 trials which met the inclusion criteria, there were 29 (20 RCTs and nine open trials). More than half (4268 [62%] of 6830) of patients with major depressive disorder reported a history of childhood trauma. The primary outcome was depression severity change from baseline to the end of the acute treatment phase, expressed as standardized effect size (Hedges’ g). Meta-analyses were done using random-effects models. Patients with childhood trauma had more severe depression at baseline, but benefitted from active treatment similarly to patients without childhood trauma history. There was no significant difference in active treatment effects (vs control condition) between individuals with and without childhood trauma. 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.
REFERENCE: Kuzminskaite, Erika et al. Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis, The Lancet Psychiatry, Volume 9, Issue 11, 2022, Pages 860-873. (https://www.sciencedirect.com/science/article/pii/S2215036622002279)