How-To Guides

Yes. In adults with current major depressive disorder, a reported history of childhood trauma was associated with a significantly increased likelihood of chronic depression, defined in this study as being depressed for 24 months or more in the past 4 years. The strongest association was seen in participants with the highest childhood trauma burden: a childhood trauma index score of 7 to 8 versus 0 was associated with chronicity with OR = 3.26 (95% CI = 1.86 to 5.72, p < .001).

No. Childhood life events such as parental loss, divorce of parents, and separation were not significantly associated with chronicity of depression in this sample of adults with major depressive disorder. For the cumulative childhood life event index, a score of 2 or more versus 0 was associated with an OR of 1.30 (95% CI = 0.71 to 2.35, p = .40), which was not statistically significant.

All four trauma types assessed in the study were significantly associated with chronicity of depression: emotional neglect, psychological abuse, physical abuse, and sexual abuse. The article reports that chronicity of depression was significantly associated with all 4 types of childhood trauma, whereas none of the measured childhood life events showed a significant association.

Yes. The study found a dose-response relationship between childhood trauma burden and chronicity of depression, meaning that higher childhood trauma index scores were associated with stronger odds of chronic depression. Although the trend was not entirely linear, the highest trauma category, score 7 to 8 versus 0, showed the strongest association, with OR = 3.26 (95% CI = 1.86 to 5.72, p < .001).

Yes. After adjustment for comorbid anxiety disorders, severity of depressive symptoms, age at onset of depression, as well as age, sex, and education, the association remained significant for participants with the highest childhood trauma burden. For childhood trauma index score 7 to 8 versus 0, the adjusted association with chronicity was OR = 2.06 (95% CI = 1.13 to 3.73, p = .018).

Chronic depression was common in this sample. Of the 1,230 adults with a current DSM-IV-TR diagnosis of major depressive disorder, 32.8% (n = 395) met the study's chronicity criterion of being depressed for 24 months or more in the past 4 years.

Higher childhood trauma burden was associated with a more complex depressive profile. Participants with the highest childhood trauma scores had significantly more comorbid anxiety disorders (p = .005), were more likely to have an onset of depression before age 21 years (p < .001), and had more severe depressive symptoms (p < .001).

This study defined chronicity of depression as being depressed for 24 months or more in the past 4 years. The definition was based on the Life Chart Interview and was not the same as DSM-IV-TR chronic major depressive disorder, which requires 24 consecutive months of depression.

The main limitations are that the analysis was cross-sectional, childhood trauma was assessed retrospectively, and the study's chronicity definition did not require 24 consecutive months of depression. Because of this design, the study cannot determine the causal pathway between childhood trauma and chronic depression, and reverse causation is possible if people with chronic depression recall or report more trauma. The authors also note that comorbid personality disorder was not assessed and could have confounded the association.

The study suggests clinicians should assess for childhood trauma, especially multiple childhood traumas, because it may indicate a more chronic course of major depressive disorder. The authors conclude that childhood trauma provides prognostic information beyond the current depressive episode's severity, age at onset, and comorbid anxiety, and they state that detecting childhood trauma is important in the treatment of depressed patients.