期刊
DEPRESSION AND ANXIETY
卷 26, 期 8, 页码 701-710出版社
WILEY
DOI: 10.1002/da.20577
关键词
major depression; mood disorders; childhood maltreatment; clinical features; treatment response
资金
- NIMH NIH HHS [U01 MH62491, U01 MH061562, U01 MH062491, UO1 MH61504, U01 MH063481, U01 MH062465, U01 MH062546, U01 MH061587, UO1 MH62546, UO1 MH61590, UO1 MH62475, U01 MH062475, U01 MH061590, UO1 MH63481, U01 MH62465, UO1 MH61587, U01 MH061504, UO1 MH61562] Funding Source: Medline
Background: There is growing evidence suggesting that early adversity may be a marker for a distinct pathway to major depressive disorder (MDD). We examined associations between childhood adversity and a broad variety of clinical characteristics and response to pharmacotherapy in a large sample of patients with chronic forms of MDD. Methods: Subjects included 808 patients with chronic forms of MDD (chronic MDD, double depression, or recurrent MDD with incomplete recovery between episodes and a total continuous duration of > 2 years) who were enrolled in a 12-week open-label trial of algorithm-guided pharmacotherapy. Baseline assessments included a semi-structured diagnostic interview, and clinician- and self-rated measures of depressive symptoms, social functioning, depressotypic cognitions, and personality traits, and childhood adversity. Patients were re-evaluated every 2 weeks. Results: A longer duration of illness; earlier onset; greater number of episodes, symptom severity, self-rated functional impairment, suicidality, and comorbid anxiety disorder; and higher levels of dysfunctional attitudes and self-criticism were each associated with multiple forms of childhood adversity. A history of maternal overcontrol, paternal abuse, paternal indifference, sexual abuse, and an index of clinically significant abuse each predicted a lower probability of remission. Among patients completing the 12-week trial, 32% with a history of clinically significant abuse, compared to 44% without such a history, achieved remission. Conclusions: These findings indicate that a history of childhood adversity is associated with an especially chronic form of MDD that is less responsive to antidepressant pharmacotherapy. Depression and Anxiety 26:701-710, 2009. Published 2009 Wiley-Liss, Inc
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