Clinical Summary
Clinical Summary: The Importance of Childhood Trauma and Childhood Life Events for Chronicity of Depression in Adults
Some adults with major depressive disorder remain depressed for years, with greater burden and harder-to-treat illness than patients with more episodic courses. This study identifies childhood trauma—not simply childhood life events such as parental loss or divorce—as a clinically useful marker of which depressed adults are more likely to have a chronic course.
Design
Baseline data, collected during 2004 through 2007, were drawn from the Netherlands Study of Depression and Anxiety (NESDA).
N
1230
Population
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).
Duration
being depressed for 24 months or more in the past 4 years
Key Findings
- The chronicity criterion was fulfilled by 32.8% (n = 395) of the 1230 depressed subjects.
- The strongest trauma-burden association was for childhood trauma index score 7 to 8 versus score 0, with OR = 3.26; 95% CI = 1.86 to 5.72, p < .001.
- The association between high childhood trauma burden and chronicity remained significant after controlling for comorbid anxiety disorders, severity of depressive symptoms, and age at onset of depression: OR = 2.06; 95% CI = 1.13 to 3.73, p = .018 for childhood trauma index score 7-8 versus score 0.
- Childhood life events were not associated with chronicity of depression: for childhood life event index score 2 or more versus score 0, OR = 1.30; 95% CI = 0.71 to 2.35, p = .40.
- Higher childhood trauma burden clustered with a more difficult depressive phenotype, including more comorbid anxiety (p = .005), more often an early age of depression onset (p < .001), and more severe depressive symptoms (p < .001).
Clinical Bottom Line
In adults with major depressive disorder, childhood trauma provides prognostic information about chronicity that is not captured by depressive severity, age at onset, or comorbid anxiety alone. A history of multiple childhood traumas should raise concern for a more chronic course of depression.
Practice Implications
- Routinely assess childhood trauma history in adults with major depressive disorder, especially when depression has been prolonged or recurrent, because the highest trauma burden was linked to chronicity with OR = 3.26; 95% CI = 1.86 to 5.72, p < .001.
- Do not treat parental loss, divorce of parents, and separation as equivalent to childhood trauma when estimating prognosis; the childhood life event index showed no association with chronicity for score 2 or more versus score 0 (OR = 1.30; 95% CI = 0.71 to 2.35, p = .40).
- When patients report multiple childhood traumas, monitor closely for comorbid anxiety, earlier onset illness, and greater symptom severity, since higher childhood trauma index scores were associated with more comorbid anxiety (p = .005), more often an early age of depression onset (p < .001), and more severe depressive symptoms (p < .001).
- Use trauma history to inform treatment planning and discussion of prognosis, because childhood trauma remained independently associated with chronicity after adjustment (OR = 2.06; 95% CI = 1.13 to 3.73, p = .018).
