Depresión adulta y experiencias infantiles adversas: evidencia de un subtipo depresivo complejo en consultantes de la atención primaria en Chile

Abstract

(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

Factors Associated with Psychiatric Comorbidity in Depression Patients in Primary Health Care in Chile

“…Regarding the impact of history of CTEs on depression [ 7 , 42 , 46 ], the findings of this study are in the same line of current literature [ 47 – 49 ]. According to the evidence accumulated during the last 30 years [ 46 – 49 ], CTEs constitute a vulnerability factor for development of adult psychopathology such as depression [ 50 ].…”

“…Regarding the impact of history of CTEs on depression [ 7 , 42 , 46 ], the findings of this study are in the same line of current literature [ 47 – 49 ]. According to the evidence accumulated during the last 30 years [ 46 – 49 ], CTEs constitute a vulnerability factor for development of adult psychopathology such as depression [ 50 ]. In addition, patients affected by depression with CTEs often develop complex clinical manifestations, which are characterized by the early onset of depression, presence of psychiatric comorbidity, recurrent MDD, increased suicide risk, and poor response to treatments validated for depression [ 51 – 54 ].…”

“…Based on our data and other studies [ 6 , 46 , 51 ], we posit that psychiatric comorbidity and CTEs are factors that could be present in the same subtype of depressive patients. Additionally, our research team has also found associations between specific CTEs and specific comorbid anxiety disorders in depressed patients: psychological abuse was associated with social phobia, and sexual abuse was associated with posttraumatic stress disorder and panic disorder [ 27 ].…”

“…Additionally, in this sample, the highest psychiatric comorbidity was associated with all the forms of interpersonal biographical trauma. In this sample we found a high frequency of CTEs, especially sexual abuse [ 26 , 27 , 46 ]. These backgrounds were the second factor—after younger age at the time of the first depressive episode—that predicted greatest psychiatric comorbidity in this sample.…”

“…The clinical complexity presented by patients with adult psychopathology and history of CTEs is an expression of neurobiological changes in epigenetics, neuro-immuno-endocrine systems and neurotransmission, and specific toxicity in brain areas, as a consequence of the exposure to damaging stressful experiences during a window of great susceptibility in the development of the mental system [ 46 – 49 ].…”