Childhood Maltreatment Predicts Unfavorable Course of Illness and Treatment Outcome in Depression: A Meta-Analysis
Abstract
Objectives:
Method:
Results:
Conclusions:
Method
Inclusion Criteria
Identification of Studies
Data Extraction
Statistical Analysis
Results
Epidemiological Studies
Authors (Reference) | Study N | Mean Age or Range (Years) | % Female | Sample Type | Depression Measure | Maltreatment Measure | Outcome Definition | Length of Observation (Years) | Results |
---|---|---|---|---|---|---|---|---|---|
Kessler and Magee (30) | 1,024 | 33 | 50 | Population | DIS, FHRDC | Own questionnaire | Recurrence: new depressive episode(s) in individuals with history of depression | 16 | Family violence associated with greater recurrence (odds ratio=2.04, 95% CI=1.42–2.93) |
Brown and Moran (31) | 404 | 18–50 | 100 | Population | PSE | CECA | Persistence: depressive episode lasting 12 months or more | 3 | Childhood adversity associated with greater persistence (odds ratio=4.02, 95% CI=1.59–10.15) |
Brown et al. (32) | 125 | 18–60 | 100 | Clinical | PSE | CECA | Persistence: nonrecovery from depression over 12 months | 2 | Childhood adversity associated with greater persistence (odds ratio=1.93, 95% CI=1.05–3.54) |
Zlotnick et al. (33) | 37 | 100 | Clinical | Semi-structured interview | Own questionnaire | Persistence: non-recovery (HAM-D <7 for 3 consecutive months after hospital discharge) | 1 | Childhood adversity not associated with persistence (odds ratio=2.29, 95% CI=0.49–10.61) | |
Kessler et al. (34) | 5,877 | 15–54 | 50 | Population | CIDI | Own questionnaire | Persistence: risk of dysthymia | 40 | Childhood adversity associated with greater persistence (odds ratio=2.81, p<0.05) |
Bernet and Stein (35) | 88 | 42 | 50 | Clinical | SCID | CTQ | Recurrence: number of depressive episodes | 25 | Childhood trauma associated with greater recurrence (t=4.78, p<0.0005) |
Hayden and Klein (36) | 86 | 31.1 | 75.6 | Clinical | SCID, longitudinal interval follow-up evaluation | EHEI | Persistence: nonrecovery from dysthymic disorder (<8 consecutive weeks with minimal or no symptoms) | 5 | Physical abuse associated with greater persistence (smaller recovery: hazard ratio=0.83, 95% CI=0.60–1.15) |
Wainwright and Surtees (37) | 3,353 | 62.3 | 55.2 | Population | Structured self-assessment | Own questionnaire | Recurrence: number of depressive episodes | 46 | Physical abuse not associated with greater recurrence (relative risk=1.27; 95% CI=0.77–1.99) |
Brown et al. (38) | 198 | 34 | 100 | Population | SCAN | CECA | Persistence: depressive episode lasting ≥12 months | 17 | Childhood adversity associated with greater recurrence (odds ratio=14.9, 95% CI=6.0–37.0) |
Collishaw et al. (39) | 3,624 | 44.2 | 50 | Population | SADS-L | CECA | Recurrence: ≥3 lifetime depressive episodes | 28 | Childhood adversity associated with greater recurrence (odds ratio=7.80, 95% CI=1.7–35.5) |
Danese et al. (7) | 1,037 | 32 | 48 | Population | DIS | Prospective observation + retrospective reports | Recurrence: ≥2 lifetime depressive episodes | 21 | Childhood adversity associated with greater recurrence (odds ratio=2.60, 95% CI=1.60–4.24) |
Ritchie et al. (40) | 942 | 72 | 58 | Population | MINI diagnosis or CES-D >16 or current antidepressant treatment | Own questionnaire | Recurrence: ≥2 depressive episodes | 4 | Childhood adversity associated with greater recurrence (odds ratio=2.89, 95% CI=1.83–4.57) |
Wiersma et al. (41) | 1,230 | 40.7 | 67.3 | Clinical | CIDI | CTI | Persistence: depressive episode lasting ≥24 months | 4 | Physical abuse associated with greater persistence (odds ratio=1.99, 95% CI=1.37–2.88) |
Angst et al. (42) | 110 | 27–41 | 60 | Clinical | SPIKE | Own questionnaire | Persistence: depressive symptoms for most days over 2 years or daily for 12 months | 13 | Childhood adversity associated with greater persistence (p=0.05) |
McLaughlin et al. (43) | 5,692 | 36.7 | 42 | Population | CIDI | Own questionnaire | Persistence: time since more recent episode, controlling for age at onset and time since onset | 20 | Physical abuse associated with greater persistence (odds ratio=1.9, 95% CI=1.5–2.4) |
Suija et al. (44) | 123 | 39 | 85 | Clinical | CIDI | CTI | Recurrence: new depressive episode in individuals with history of depression | 1 | Childhood trauma associated with greater recurrence (odds ratio=1.58, 95% CI=1.05–2.38) |
Publication bias.
Sensitivity analyses.
Bias owing to study quality.
Effect of age at illness onset.
Recall bias.
Clinical Trials
Authors (Reference) | Study N | Mean Age (Years) | % Female | Depression Measure | Maltreatment Measure | Treatment Description | Length of Treatment (Weeks) | Outcome Definition | Results |
---|---|---|---|---|---|---|---|---|---|
Sakado et al. (45) | 60 | 43 | 50 | SCID | PBI | Tricyclic antidepressant | 16 | Remission: HAM-D-17 <8 | Low paternal care associated with lack of remission (odds ratio=1.9, 95% CI=1.7–2.2) |
Nemeroff et al. (46) | 681 | 43 | 65.3 | SCID | CTS | CBASP, nefazodone, combination | 12 | Improvement: HAM-D-24 score reduction | Childhood abuse associated with poor outcome within the pharmacological treatment arm and good outcome within the psychotherapy treatment arm (trauma-by-treatment interaction F=3.13, df=1, 495, p=0.045) |
Barbe et al. (47) | 107 | 15.8 | 75.7 | K-SADS; BDI ≥ 13 | CBQ | CBT, SBFT, NST | 12–16 | Remission: free from major depressive disorder diagnosis for ≥2 months | Family conflict associated with lack of remission (relative risk=0.95, 95% CI=0.91–0.998) |
Enns and Cox (48) | 171 | 41.8 | 64.3 | Unstructured interview | DMQ, PBI | Various antidepressants and psychological treatments | 52 | Response: 50% decrease in BDI scoreRemission: BDI <10 | Sexual abuse associated with lack of response (χ2=4.32, p=0.038) and lack of remission (χ2=4.38, p=0.036); low parental care or overprotection were unrelated to outcome (p=0.58) |
Asarnow et al. (49) | 287 | 15.9 | 69.8 | CDRS-R ≥40; CGI ≥4; resistance to SSRIs | CBQ, clinical interview | Medication switch alone (SSRI or venlafaxine), medication switch plus CBT | 12 | Response: CDRS-R score reduction ≥50% | Childhood abuse associated with lack of response to CBT but not to pharmacotherapy or combination (abuse-by-treatment interaction β=0.15, p<0.001) |
Johnstone et al. (50) | 195 | 32 | 57 | Not specified | PBI, own questionnaire | Fluoxetine, nortriptyline | 6 | Improvement: MADRS score percentage reduction | Maternal overprotection was associated with less improvement (odds ratio=0.93, 95% CI=0.89–0.97). Parental care and childhood abuse were unrelated to outcome |
Klein et al. (51) | 808 | 43.6 | 55 | SCID, HAM-D-17 ≥20 | MOPS, CTQ | Texas Medication Algorithm | 12 | Remission: HAM-D-17 <8 | Childhood abuse associated with lack of remission (odds ratio=0.52, p<0.01) |
Shirk et al. (52) | 50 | 15.9 | 68 | C-DISC-IV | LEQ | CBT | 12 | Remission: free from major depressive disorder diagnosis at the end of treatment Improvement: BDI score reduction | Childhood trauma associated with lack of remission (ρ=–0.31 to –0.35, p<0.05) |
Lewis et al. (53) | 427 | 14.6 | 54 | K-SADS-PL, CDRS-R >45 | PTSD section of K-SADS-PL | Fluoxetine, CBT, combination, placebo | 12 | Improvement: reduction in CDRS-R score | Childhood trauma associated with poor response to CBT but not with response to fluoxetine or combination treatment (trauma-by-treatment-by-time interaction F=2.02, p<0.05) |
Miniati et al. (54) | 312 | 39 | 73 | SCID | Clinical interview | Medication (citalopram or escitalopram), IPT, combination | 12 | Time to remission (Remission: HAM-D-17 <8) | Childhood abuse associated with longer time to remission across treatments (hazard ratio=1.68, 95% CI=1.09–2.59) |
Publication bias.
Sensitivity analyses.
Bias owing to study quality.
Age effect.
Discussion
Limitations
Implications
Future research.
Clinical care.
Public health.
Acknowledgments
Footnote
Supplementary Material
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