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Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis.

Abstract

OBJECTIVES
Evidence suggests that childhood maltreatment may negatively affect not only the lifetime risk of depression but also clinically relevant measures of depression, such as course of illness and treatment outcome. The authors conducted the first meta-analysis to examine the relationship between childhood maltreatment and these clinically relevant measures of depression.
METHOD
The authors conducted searches in MEDLINE, PsycINFO, and Embase for articles examining the association of childhood maltreatment with course of illness (i.e., recurrence or persistence) and with treatment outcome in depression that appeared in the literature before December 31, 2010. Recurrence was defined in terms of number of depressive episodes. Persistence was defined in terms of duration of current depressive episode. Treatment outcome was defined in terms of either a response (a 50% reduction in depression severity rating from baseline) or remission (a decrease in depression severity below a predefined clinical significance level).
RESULTS
A meta-analysis of 16 epidemiological studies (23,544 participants) suggested that childhood maltreatment was associated with an elevated risk of developing recurrent and persistent depressive episodes (odds ratio=2.27, 95% confidence interval [CI]=1.80–2.87). A meta-analysis of 10 clinical trials (3,098 participants) revealed that childhood maltreatment was associated with lack of response or remission during treatment for depression (odds ratio=1.43, 95% CI=1.11–1.83). Meta-regression analyses suggested that the results were not significantly affected by publication bias, choice of outcome measure, inclusion of prevalence or incidence samples, study quality, age of the sample, or lifetime prevalence of depression.
CONCLUSIONS
Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression.

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  • Publisher Full Text
  • Authors

    Nanni V, Uher R, Danese A

    Institution

    King's College London, Institute of Psychiatry, MRC Social, Genetic, and Developmental Psychiatry Research Centre, UK.

    Source

    The American journal of psychiatry 169:2 2012 Feb pg 141-51

    MeSH

    Adult
    Adult Survivors of Child Abuse
    Antidepressive Agents
    Child
    Child Abuse
    Confidence Intervals
    Depressive Disorder
    Drug Therapy
    Epidemiologic Studies
    Episode of Care
    Humans
    Outcome and Process Assessment (Health Care)
    Prevalence
    Psychiatric Status Rating Scales
    Recurrence
    Remission Induction
    Risk Factors
    Treatment Failure

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22420036