Childhood neglect predicts the course of major depression in a tertiary care sample: a follow-up study

Abstract

BackgroundThe course of depression is poorer in clinical settings than in the general population. Several predictors have been studied and there is growing evidence that a history of childhood maltreatment consistently predicts a poorer course of depression.MethodsBetween 2008 and 2012, we assessed 238 individuals suffering from a current episode of major depression. Fifty percent of these (N = 119) participated in a follow-up study conducted between 2012 and 2014 that assessed sociodemographic and clinical variables, the history of childhood abuse and neglect (using the Adverse Childhood Experience questionnaire), and the course of depression between baseline and follow-up interview (using the Life Chart method). The Structured Clinical Interview for DSM-IV-TR was used to assess diagnosis at baseline and follow-up interview. Statistical analyses used the life table survival method and Cox proportional hazard regression tests.ResultsAmong 119 participants, 45.4% did not recover or remit during the follow-up period. The median time to remission or recovery was 28.9 months and the median time to the first recurrence was 25.7 months. Not being married, a chronic index depressive episode, comorbidity with an anxiety disorder, and a childhood history of physical neglect independently predicted a slower time to remission or recovery. The presence of three or more previous depression episodes and a childhood history of emotional neglect were independent predictors of depressive recurrences.ConclusionsChildhood emotional and physical neglect predict a less favorable course of depression. The effect of childhood neglect on the course of depression was independent of sociodemographic and clinical variables.

Recurrence and chronicity of major depressive disorder and their risk indicators in a population cohort

“…Similar to previous studies , childhood abuse, higher number of previous depressive episodes and severe depression at baseline were significantly related to shorter time to recurrence. The finding that lower mental functioning was significantly related to shorter time to recurrence also confirms earlier research .…”

“…With respect to vulnerability characteristics, studies focused on childhood abuse and parental or familial psychopathology in particular (in three and five studies respectively). While two studies found evidence for childhood abuse as a risk indicator for recurrence , one study did not find such association . The opposite was true for parental or familial psychopathology ( vs. ) and psychiatric comorbidity ( vs. ), where more studies did not find than did find such association.…”

“…While two studies found evidence for childhood abuse as a risk indicator for recurrence , one study did not find such association . The opposite was true for parental or familial psychopathology ( vs. ) and psychiatric comorbidity ( vs. ), where more studies did not find than did find such association. The majority of clinical studies did not evaluate the role of functioning as risk indicator of recurrence, except the primary care studies , and the assessment of physical health was most often confined to the number of chronic somatic disorders.…”

“…), thereby creating a more homogenous group at the start. Furthermore, in other studies most patients showed a rather poor course at follow‐up as a result of which among only a small number of remitted cases recurrence could be assessed . Despite these limitations, in these studies most evidence was found for clinical depression characteristics as risk indicators for recurrence (see ).…”

“…Despite these limitations, in these studies most evidence was found for clinical depression characteristics as risk indicators for recurrence (see ). Within this category, the number of previous episodes and severity have been most frequently studied (in seven of the eight studies), and much evidence was found for a higher number of previous depressive episodes as risk indicator for recurrence than for severe depression at baseline .…”