An outpatient intervention that screened for and focused on childhood traumas and that helped patients understand current psychosocial difficulties as a repetition of past traumas was effective in reducing psychiatric symptoms and improving interpersonal relationships and social role functioning among women with severe depression and a history of childhood trauma.

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(r = 0.19; p < 0.01), psychiatric comorbidities (r = 0.23; p < 0.01), partner violence events (r = 0.31; p < 0.01), vital stressful events (r = 0.12; p < 0.01), number of depressive episodes (r = 0.16; p < 0.01), duration of the longer depressive episode (r = 0.12; p < 0.05) and suicidal tendency according to HDRS (r = 0.16; p < 0.01). An inverse correlation was observed between frequency of ACE and age at the first depressive episode (r = -0.12; p < 0.05). Conclusions: These data are consistent with the hypothesis that early trauma is associated with more severe and complex depressive episodes during adulthood. (Rev Med Chile 2017; 145: 1145-1153

Further clinical recognition is required in patients seeking help for depression in primary care. This recognition must take into account the patient's current psychiatric comorbidities and adverse childhood experiences.

An outpatient intervention that screened for and focused on childhood traumas and that helped patients understand current psychosocial difficulties as a repetition of past traumas was effective in reducing psychiatric symptoms and improving interpersonal relationships and social role functioning among women with severe depression and a history of childhood trauma.

In the last two decades, different research has demonstrated the high prevalence of childhood trauma, including sexual abuse, among depressive women. These findings are associated with a complex, severe, and chronic psychopathology. This can be explained considering the neurobiological changes secondary to early trauma that can provoke a neuroendocrine failure to compensate in response to challenge. It suggests the existence of a distinguishable clinical-neurobiological subtype of depression as a function of childhood trauma that requires specific treatments. Among women with depression and early trauma receiving treatment in a public mental health service in Chile, it was demonstrated that a brief outpatient intervention (that screened for and focused on childhood trauma and helped patients to understand current psychosocial difficulties as a repetition of past trauma) was effective in reducing psychiatric symptoms and improving interpersonal relationships. However, in this population, this intervention did not prevent posttraumatic stress disorder secondary to the extreme earthquake that occurred in February 2010. Therefore in adults with depression and early trauma, it is necessary to evaluate prolonged multimodal treatments that integrate pharmacotherapy, social support, and interpersonal psychotherapies with trauma focused interventions (specific interventions for specific traumas).

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Resumen Introducción Existe alta prevalencia de alteraciones emocionales en la población expuesta a desastres y los centros de atención primaria de salud (APS) podrían contribuir a su prevención. Objetivo Analizar asociaciones post-catástrofe entre variables de APS y variables de salud mental de la población. Método Estudio efectuado en Chile un año después de un terremoto de 8,8° Richter. Se aplicó un cuestionario de intensidad de acciones de salud mental en 16 centros APS y las escalas GHQ-12 y SF-36 para malestar psicológico y calidad de vida en una muestra basada en hogares y otra de consultantes a APS. Se efectuó un análisis de regresión lineal múltiple para las dos poblaciones y los dos instrumentos. Resultados Ninguna de las variables sobre intensidad de acciones de APS mostró relación con GHQ-12 o SF-36 en ambas muestras. Las variables asociadas significativamente a mayor puntaje en GHQ-12 y menor puntaje en SF-36 fueron sexo femenino, baja escolaridad, baja situación económica, menor apoyo social y daños producidos por el terremoto. Conclusión El equipo APS podría lograr un mayor efecto preventivo post-catástrofe trabajando con otros sectores que incluyan la dimensión salud mental en el abordaje de los problemas sociales críticos en situaciones de desastres, y reservando el trabajo preventivo directo para las personas con alta vulnerabilidad psicológica.