The Importance of Childhood Trauma and Childhood Life Events for Chronicity of Depression in Adults

Background: Childhood trauma is linked to adult depression and might be a risk factor for a more chronic course of depression. However, the link between childhood trauma and chronicity of depression has not been investigated using a large and representative sample in which other depression characteristics, such as severity, age at onset, and comorbid psychopathology, were taken into account.

Method: Baseline data, collected during 2004 through 2007, were drawn from the Netherlands Study of Depression and Anxiety (NESDA). Participants had a current DSM-IV-TR diagnosis of major depressive disorder (MDD) and were recruited from the community, primary care settings, and specialized mental health care facilities (N=1230). Relationships between both childhood trauma and childhood life events and chronicity of depression were examined using multiple logistic regression models. Chronicity of depression was defined as being depressed for 24 months or more in the past 4 years.

Results: Chronicity of depression was associated with a significantly higher prevalence of childhood trauma but was not associated with childhood life events. We found the strongest association for those with the highest score on a cumulative index summarizing frequency of childhood trauma (OR=3.26; 95% CI=1.86 to 5.72, p<.001). After controlling for comorbid anxiety disorders, severity of depressive symptoms, and age at onset of depression, we found that the association between childhood trauma index and chronicity of depression remained significant (OR=2.06; 95% CI=1.13 to 3.73, p=.02).

Conclusions: These results suggest that multiple childhood traumas can be seen as an independent determinant of chronicity of depression. For treatment of depressed patients, it is therefore important to detect the presence of childhood trauma.

J Clin Psychiatry 2009;70(7):983-989