Do adults who have experienced childhood trauma benefit from traditional depression treatment?

A comprehensive study has been published in The Lancet Psychiatry on the treatment of adults who have a history of childhood trauma. The study found, contrary to previous findings that suggested traditional treatment for depression would not be effective, that the medication and psychotherapy used to treat major depressive disorder improved the symptoms of those adults involved.

Written by Bryony Porteous-Sebouhian

Childhood trauma and major depression

Experiencing childhood trauma can lead to the development of various mental health conditions. From trauma disorders such as post-traumatic stress disorder (PTSD), dissociative disorders, or anxiety disorders, depressive disorders, and other conditions such as obsessive-compulsive disorder (OCD).

In psychiatry, childhood trauma is generally defined as emotional/physical neglect or emotional/physical/sexual abuse before the age of 18. Childhood trauma is a known risk factor for the development of major depressive disorder, thought of by many within the field to be one of the more complex psychiatric disorders to treat. So much so, in fact, that alternative treatments such as psychedelic assisted therapy are currently being trialed for their effectiveness.

Adults who have experienced childhood trauma and who are diagnosed with major depressive disorder often present symptoms at an earlier onset and experience longer lasting and more frequently occurring symptoms too.

Previous studies had suggested that diagnosed adults and adolescents who had experienced childhood trauma were less likely to respond positively to traditional treatments for depression: pharmacology, psychotherapy or a combination of the two.

However, the new study appears to disprove this assumption.

What did this latest study find?

The study, which has been the largest and most comprehensive of its kind, examined the effectiveness of traditional treatments for major depression on those with childhood trauma and found:

• Based on data from over 29 clinical trials, covering a database of 6,830 patients, 62.5% reported a history of childhood trauma.
• Over half of the clinical trials were based in Europe (51.7%) while a further 31% were based in North America.
• Researchers used the Beck Depression Inventory or the Hamilton Rating Scale for Depression to measure depression severity.
• Researchers asked three questions: were childhood trauma patients more severely depressed prior to treatment? Were there more ‘unfavourable outcomes’ for childhood trauma patients following treatment? And finally, were childhood trauma patients less likely to benefit from active treatment than those without childhood trauma?

Researchers found that those with childhood trauma did in fact present greater symptom severity at the start of treatment than those without childhood trauma. The researchers pointed out the importance of this factor, stating that it ‘highlights the importance of taking symptom severity into account when calculating treatment effects.’

Despite the presence of more severe symptoms however, childhood trauma patients actually experienced a similar rate of symptom improvement when compared to depressed patients without a history of childhood trauma.

First author of the study, Erika Kuzminskaite speaking on the study’s importance regarding treatment offerings for those who have experienced childhood trauma said:

“This study is the largest of its kind to look at the effectiveness of depression treatments for adults with childhood trauma and is also the first to compare the effect of active treatment with control condition (waitlist, placebo, or care-as-usual) for this population. Around 46% of adults with depression have a history of childhood trauma, and for chronic depression sufferers the prevalence is even higher. It is therefore important to determine whether current treatments offered for major depressive disorder are effective for patients with childhood trauma.”

Importantly, this study indicates that, when tailored correctly (by identifying the severity of symptoms in relation to the presence of childhood trauma), traditional treatment for depression can be effective.

Researchers also found that treatment dropout rates were similar for those with and without childhood trauma and the treatment efficacy did not vary by trauma type, depression diagnosis, assessment method of childhood trauma, study quality, year, or treatment type and length.

Kuzminskaite continued:

“Finding that patients with depression and childhood trauma experience similar treatment outcome when compared to patients without trauma can give hope to people who have experienced childhood trauma.”

She also added however, that patients with childhood trauma do require more long-term treatment, adding that:

“Residual symptoms following treatment in patients with childhood trauma warrant more clinical attention as additional interventions may still be needed. To provide further meaningful progress and improve outcomes for individuals with childhood trauma, future research is necessary to examine long-term treatment outcomes and mechanisms through which childhood trauma exerts its long-lasting effects.”

The authors also acknowledged some of the limitations of the study. Stating that the high variety of results and the fact that the childhood trauma was all reported retrospectively might have affected the accuracy of the data collected. Researchers also acknowledged the likelihood of relapse in patients with major depression and childhood trauma, stating that they have a ‘high risk’ of relapse and thus ‘they may benefit from treatment significantly less than patients without childhood trauma in the long turn.’

Though this study has limits, like all studies, the results do show some positive outcomes that could work to relief the long-term symptoms that those who have experienced childhood trauma live with in their day to day lives. Treatment for depression is far more accessible and available than treatment for trauma in the NHS and so this approach could be used to treat people while they are waiting for the specialist help they need.?