Article summary of Childhood maltreatment predicts an unfavorable course of illness and treatment outcome in depression: a meta-analysis by Nanni et al. - Chapter

Preface

Social relevance

Depressions have major consequences for health and cause a high economic burden for society. Because of this, it is important to study the risks of developing recurrent and severe depression and inadequate responding to treatment.

The role of child abuse

Child abuse predicts an unfavorable course of depression and leads to unfavorable treatment outcomes. People who have experienced child abuse have a high risk on developing depression.

Meta-analysis

This article describes a meta-analysis that examines the relationship between child abuse and an increased risk of depression and negative treatment outcomes. For people with depression and a history of child abuse, it was checked whether there were recurrent depressive periods and persistent depressive symptoms. The relationship between child abuse and various treatments was also examined. The types of treatment considered are psychological and pharmacological (medication) treatments and a combination of the two.

Method

Literature has been used that describes the relationship between child abuse and disease progression (such as recurrence and persistence) and treatment outcomes in depression. Recurrence was defined in terms of the number of depressive periods. Persistence was defined as the duration of the current depression. Treatment outcome was defined in terms of treatment response and remission (reduction or disappearance of symptoms of depression).

Results

Epidemiological studies

A meta-analysis among these studies showed that people with a history of child abuse were twice as likely to have an unfavorable course of depression than people without a history of child abuse.

Recurrence and severity of depression

The results showed that people with a history of child abuse suffered twice as often from recurrent depressive periods compared to people without a history of child abuse. The severity and persistence of depressive symptoms was also investigated in the group with a history of child abuse. This group also appeared to suffer twice as often from more severe and persistent depression periods.

Treatment outcomes: psychotherapy, pharmacology, combination therapy

The results of the meta-analysis showed that people with a history of child abuse were more likely to respond poorly to treatment compared to people without a history of child abuse. In psychotherapy, people who had been abused, did not significantly respond poorly to treatments. For pharmacology, a significantly higher risk was found for poor treatment outcomes in people with a history of child abuse. The group of abused persons also appeared to achieve a worse treatment result when in combined (psychological and pharmacological) treatment.

Discussion

This meta-analysis showed that people with a history of child abuse had recurrent and persistent depressive symptoms twice as often as people without a history of child abuse. This group of abused persons also appeared to benefit less from treatments. This in turn is a risk factor for recurrent and persistent depressive periods. In the context of depression, early prevention of child abuse is important for improving health and reducing the economic burden.