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Published Online: 1 February 2012

Childhood Maltreatment Predicts Unfavorable Course of Illness and Treatment Outcome in Depression: A Meta-Analysis

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Abstract

Objectives:

Evidence suggests that childhood maltreatment may negatively affect not only the lifetime risk of depression but also clinically relevant measures of depression, such as course of illness and treatment outcome. The authors conducted the first meta-analysis to examine the relationship between childhood maltreatment and these clinically relevant measures of depression.

Method:

The authors conducted searches in MEDLINE, PsycINFO, and Embase for articles examining the association of childhood maltreatment with course of illness (i.e., recurrence or persistence) and with treatment outcome in depression that appeared in the literature before December 31, 2010. Recurrence was defined in terms of number of depressive episodes. Persistence was defined in terms of duration of current depressive episode. Treatment outcome was defined in terms of either a response (a 50% reduction in depression severity rating from baseline) or remission (a decrease in depression severity below a predefined clinical significance level).

Results:

A meta-analysis of 16 epidemiological studies (23,544 participants) suggested that childhood maltreatment was associated with an elevated risk of developing recurrent and persistent depressive episodes (odds ratio=2.27, 95% confidence interval [CI]=1.80–2.87). A meta-analysis of 10 clinical trials (3,098 participants) revealed that childhood maltreatment was associated with lack of response or remission during treatment for depression (odds ratio=1.43, 95% CI=1.11–1.83). Meta-regression analyses suggested that the results were not significantly affected by publication bias, choice of outcome measure, inclusion of prevalence or incidence samples, study quality, age of the sample, or lifetime prevalence of depression.

Conclusions:

Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 141 - 151
PubMed: 22420036

History

Received: 28 February 2011
Revision received: 9 May 2011
Accepted: 26 May 2011
Published online: 1 February 2012
Published in print: February 2012

Authors

Details

Valentina Nanni, M.D.
From King's College London, Institute of Psychiatry, MRC Social, Genetic, and Developmental Psychiatry (SGDP) Research Centre; and King's College London, Institute of Psychiatry, Department of Child and Adolescent Psychiatry in London.
Rudolf Uher, M.U.Dr., Ph.D.
From King's College London, Institute of Psychiatry, MRC Social, Genetic, and Developmental Psychiatry (SGDP) Research Centre; and King's College London, Institute of Psychiatry, Department of Child and Adolescent Psychiatry in London.
Andrea Danese, M.D., Ph.D.
From King's College London, Institute of Psychiatry, MRC Social, Genetic, and Developmental Psychiatry (SGDP) Research Centre; and King's College London, Institute of Psychiatry, Department of Child and Adolescent Psychiatry in London.

Notes

Address correspondence to Dr. Danese ([email protected]).

Funding Information

The authors report no financial relationships with commercial interests. Dr. Nanni is supported by a fellowship for higher training in Psychiatry from the Italian Ministry of University and Scientific Research. Dr. Uher is supported by a grant from the European Commission (Grant Agreement #115008). Dr. Danese is supported by a NARSAD Young Investigator Award.

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