An earlier version of this paper was presented at the Annual Meeting of the American Psychological Association, San Francisco, CA, August 2007.
Article first published online: 11 MAY 2009
This article is a US Government work and, as such, is in the public domain in the United States of America. Published in 2009 by Wiley-Liss, Inc.
Depression and Anxiety
Volume 26, Issue 8, pages 701–710, August 2009
How to Cite
Klein, D. N., Arnow, B. A., Barkin, J. L., Dowling, F., Kocsis, J. H., Leon, A. C., Manber, R., Rothbaum, B. O., Trivedi, M. H. and Wisniewski, S. R. (2009), Early adversity in chronic depression: clinical correlates and response to pharmacotherapy. Depress. Anxiety, 26: 701–710. doi: 10.1002/da.20577
This article is a US Government work and, as such, is in the public domain in the United States of America.
- Issue published online: 27 JUL 2009
- Article first published online: 11 MAY 2009
- Manuscript Accepted: 10 APR 2009
- Manuscript Revised: 7 APR 2009
- Manuscript Received: 19 FEB 2009
- NIMH. Grant Numbers: UO1 MH62475, UO1 MH61587, UO1 MH62546, UO1 MH61562, UO1 MH63481, U01 MH62465, UO1 MH61590, UO1 MH61504, U01 MH62491
- major depression;
- mood disorders;
- childhood maltreatment;
- clinical features;
- treatment response
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, 2009. Published 2009 Wiley-Liss, Inc.