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Early adversity in chronic depression: clinical correlates and response to pharmacotherapy
Author(s) -
Klein Daniel N.,
Arnow Bruce A.,
Barkin Jennifer L.,
Dowling Frank,
Kocsis James H.,
Leon Andrew C.,
Manber Rachel,
Rothbaum Barbara O.,
Trivedi Madhukar H.,
Wisniewski Stephen R.
Publication year - 2009
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.20577
Subject(s) - major depressive disorder , depression (economics) , pharmacotherapy , dysfunctional family , psychiatry , clinical psychology , anxiety , psychology , antidepressant , borderline personality disorder , sexual abuse , major depressive episode , mood , poison control , medicine , injury prevention , environmental health , economics , macroeconomics
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.