The contribution of early adverse stress to complex and severe depression in depressed outpatients

Abstract

Background To assess whether linear effects or threshold effects best describe the association between early adverse stress (EAS) and complex and severe depression (i.e., depression with treatment resistance, psychotic symptoms, and/or suicidal ideation), and to examine the attributable risk of complex and severe depression associated with EAS. Methods A cross‐sectional study was conducted using deidentified clinical data (on demographics, presence of complex and severe depression, and exposure to seven types of EAS) from 1,013 adults who were seen in an outpatient mental health clinic in Santiago, Chile, for a major depressive episode. Multivariate logistic regressions were fitted to estimate odds ratios (ORs), using a bootstrap approach to compute 95% bias‐corrected confidence intervals (95% BC CIs). A detailed examination of the cumulative risk score and calculations of the attributable risk was conducted. Results Exposure to at least five EASs was reported by 3.6% of the sample. In the multivariate logistic regression models, there was a marked increase in the odds of having complex and severe depression associated with exposure to at least five EASs (OR = 4.24; 95% BC CI: 1.25 to 9.09), according to a threshold effect. The attributable risk of complex and severe depression associated with exposure to at least one EAS was 36.8% (95% BC CI: 17.7 to 55.9). Conclusions High levels of EAS distinctively contribute to complex clinical presentations of depression in adulthood. Patients with complex clinical presentations of depression and history of EAS should need a differentiated treatment approach, particularly those having high levels of EAS.

Defense mechanisms mediate associations between exposure to adverse childhood experiences and anxiety and depression in Kenyan adolescents.

“…Meanwhile, not all victims develop PTSD following trauma; some may suffer disturbances in daily functioning but gradually return to normal, while other people maintain clinically significant psychological comorbidities such as anxiety and depression which require prolonged intervention (Briere, 2004; Hill, 2003). Previous research has observed that ACEs are widely common in individuals suffering from high severity of depression symptoms (Bellis et al, 2014; Gloger et al, 2021; Nelson et al, 2017). Likewise, the association between higher exposure to ACEs and higher severity of anxiety and depression symptoms in adolescent samples (Gloger et al, 2021; Goldenson et al, 2020; Waikamp & Serralta, 2018) is consistent in several studies in European, North American, Asian, and Latin American samples.…”

“…Previous research has observed that ACEs are widely common in individuals suffering from high severity of depression symptoms (Bellis et al, 2014; Gloger et al, 2021; Nelson et al, 2017). Likewise, the association between higher exposure to ACEs and higher severity of anxiety and depression symptoms in adolescent samples (Gloger et al, 2021; Goldenson et al, 2020; Waikamp & Serralta, 2018) is consistent in several studies in European, North American, Asian, and Latin American samples.…”

Endo-Lysosomal and Autophagy Pathway and Ubiquitin-Proteasome System in Mood Disorders: A Review Article

“…For the environmental conditions, several risk factors have been associated with increased risk of developing MDD and BD including, early adverse stress, psychological stressors, and drug abuse. 3–5 The combination of environmental and genetic factors may lead to intermediate phenotypes, such as altered brain gene expression and circuitry dysfunction, that affect mood disturbances. 6 These alterations may be associated with changes in different cellular pathways that culminate in inflammation, 7 , 8 decreased neuroplasticity, 9 increased oxidative stress, 10 and cell death.…”