The impact of adverse childhood experiences on adult depression severity and treatment outcomes

Direct and indirect effects of adverse and protective childhood experiences on symptom improvement in psychotherapy

To investigate the effects of adverse and protective childhood experiences on symptom improvement in outpatient psychotherapy.

We evaluated n = 648 completed outpatient psychodynamic psychotherapies. First, we estimated the rate of symptom improvement for each patient using a two-stage hierarchical linear model. We then calculated the direct and indirect influences of childhood experiences on the improvement rate using a structural equation model. Personality functioning, according to the Operationalized Psychodynamic Diagnosis system, was examined as being a possible mediating factor.

The presence of adverse childhood experiences was directly associated with a slower improvement rate in psychotherapy. Moreover, a higher number of adverse childhood experiences was associated with greater impairments in the ability to communicate as one dimension of personality functioning, which in turn was associated with a slower improvement of symptoms. Protective childhood experiences were associated with fewer impairments in specific dimensions of personality functioning, but had no direct effect on the improvement rate.

Adverse childhood experiences can directly influence the course of psychotherapy. In addition, the communication dimension of personality functioning appears to be a central mediator on which adverse and protective childhood experiences act antagonistically and can thus indirectly affect the improvement rate in psychotherapy.

Complex Intersections Between Adverse Childhood Experiences and Negative Life Events Impact the Phenome of Major Depression

Background

There is evidence that adverse childhood experiences (ACEs) and negative life events (NLEs) are associated with major depression (MDD).

Purpose

To determine whether ACEs affect all features of mild MDD, including suicidal tendencies, brooding, neuroticism, insomnia, cognitive deficits, severity of depression and anxiety, and cognitive deficits, and whether NLEs mediate these effects.

Sample of the Study and Methods

This study examines a cohort of 118 academic students, namely 74 students who satisfied the DSM-5-TR criteria for MDD and 44 normal control students. We assessed brooding, neuroticism, suicidal ideation and attempts, and the severity of depression, anxiety, insomnia, and the Stroop tests.

Results

One validated factor could be extracted from brooding, neuroticism, current suicidal behaviors, and the severity of depression, anxiety, and insomnia, labeled the phenome of depression. A large part of the variance in the phenome of depression (55.0%) was explained by the combined effects of self-, relationships, and academic-related NLEs in conjunction with ACEs, including family dysfunction and abuse and neglect (both physical and emotional). The latter ACEs significantly interacted (moderating effect) with NLEs to impact the depression phenome. Although sexual abuse did not have direct effects on the phenome, its effects were mediated by NLEs. We discovered that increased sexual abuse, physical and emotional abuse and neglect, and ACEs related to family dysfunction predicted 22.5% of the variance in NLEs. Up to 18.5% of the variance in the Stroop test scores was explained by sexual abuse and the phenome of depression. The latter mediated the effects of NLEs and abuse, neglect, and family dysfunction on the Stroop test scores.

Conclusion

Complex intersections between ACEs and NLEs impact the phenome of depression, which comprises neuroticism, brooding, suicidal tendencies, and the severity of insomnia, anxiety, and depression, while sexual abuse together with other ACEs and NLEs may impact cognitive interference inhibition.

Examining childhood experiences and personality functioning as potential predictors for the speed of recovery during psychotherapy of patients with anxiety disorders

Background

Adverse childhood experiences were previously identified as relevant risk factors for the development of anxiety disorders. Furthermore, anxiety disorders were shown to be associated with impairments of personality functioning. The objective of this study was to investigate adverse and protective childhood experiences as well as personality functioning, as defined by the Operationalized Psychodynamic Diagnosis system, as potential predictors for the speed of recovery during psychotherapy for patients with anxiety disorders.

Methods

The sample consisted of n = 312 completed psychotherapies. The speed of recovery, defined as symptom abatement over time, was calculated using a two-stage hierarchical linear model. The effects of adverse and protective childhood experiences as well as personality functioning on the speed of recovery during psychotherapy were then examined using a structural equation model.

Results

The presence of adverse childhood experiences predicted a lower speed of recovery during psychotherapy. In addition, a higher number of adverse childhood experiences was associated with greater impairments in the abilities of perception and regulation as dimensions of personality functioning. A higher number of protective childhood experiences was associated with fewer impairments in the communication and attachment dimensions. Impairments in personality functioning in patients with anxiety disorders did not predict the speed of recovery during psychotherapy.

Conclusions

Among patients with anxiety disorders, adverse childhood experiences lead to a lower speed of recovery during psychotherapy. Therefore, childhood adversity should be routinely assessed before and thoroughly addressed during psychotherapy in patients with anxiety disorders.

Self-concept mediates the relationships between childhood traumatic experiences and adolescent depression in both clinical and community samples

BACKGROUND

Childhood trauma is a pivotal risk factor for adolescent depression. While the association between childhood trauma and depression is well-established, the mediating role of self-concept has not been acknowledged. Specifically, limited attention has been paid to how childhood maltreatment impacts adolescent depression through physical and social self-concept, both in clinical and community samples. This study aims to investigate how distinct and cumulative childhood trauma affects adolescent depression, as well as the potential mediating role of self-concept in their relationships.

METHODS

We recruited 227 depressed adolescents (dataset 1, 45 males, age = 15.34 ± 1.96) and 574 community adolescents (dataset 2, 107 males, age = 16.79 ± 0.65). Each participant was assessed on five subtypes of childhood trauma severity, cumulative trauma index, physical and social self-concept, and depression. Mediation models were tested separately in the clinical and community samples.

RESULTS

Clinically depressed adolescents experienced a higher level of trauma severity, a greater number of trauma subtypes, and had lower levels of physical and social self-concept compared to community adolescents. Analyses on childhood trauma severity and cumulative trauma index jointly indicated that physical and social self-concept played mediation roles in the relationships between childhood trauma experiences and depression. Moreover, the mediating effects of self-concept were stronger in depressed adolescents when compared to community samples.

CONCLUSIONS

Our findings suggest that physical and social self-concept play mediating roles in the pathway linking childhood trauma and adolescent depression, particularly in clinically depressed individuals.

Childhood and adulthood trauma exposure: Associations with perinatal mental health and psychotherapy response

Trauma exposure is strongly linked to maternal posttraumatic stress disorder (PTSD) and depressive symptoms during the perinatal period; however, childhood trauma exposure is often assessed without accounting for adult exposure. This study tested the unique impacts of childhood and adulthood trauma exposure on PTSD and depressive symptoms among pregnant women (N = 107, 82.9% Latina) enrolled in a nonrandomized intervention study. Regression analyses at baseline showed positive associations between trauma exposure and PTSD symptoms irrespective of trauma timing, childhood: B = 1.62, t(91) = 2.11, p = .038; adulthood: B = 2.92, t(91) = 3.04, p = .003. However only adulthood trauma exposure, B = 1.28, t(94) = 2.94, p = .004, was positively associated with depressive symptoms. Mixed-effects analyses of variance revealed interaction effects of time and adulthood trauma exposure, indicating that women with high degrees of adulthood trauma exposure had higher baseline levels of PTSD, F(1, 76.4) = 6.45, p = .013, and depressive symptoms, F(1, 87.2) = 4.88, p = .030, but showed a more precipitous decrease posttreatment than women with lower levels of adulthood trauma exposure. These findings support the clinical relevance of assessing both childhood and adulthood trauma exposure during the perinatal period given their impacts on baseline symptoms and psychotherapy response.

Linking trauma to mental health in the statewide Texas Youth Depression and Suicide Research Network (TX-YDSRN)

Rates of youth depression and suicide are rising worldwide and represent public health crises. The present study examined the relationship between trauma history and symptoms of depression, suicidal ideation, and anxiety among suicidal and depressed youth. A diverse group of 1000 8-20-year-olds enrolled in the statewide Texas Youth Depression and Suicide Research Network (TX-YDSRN) reported their trauma history (Traumatic Events Screening Inventory for Children) and symptoms of depression (Patient Health Questionnaire for adolescents; PHQ-A), anxiety (Generalized Anxiety Disorder scale; GAD-7), and suicidality (Concise Health Risk Tracking scale; CHRT-SR). Nearly half of the sample reported exposure to multiple categories of traumatic experiences. Number of trauma exposure categories significantly predicted PHQ-A and GAD-7 scores. Exposure to interpersonal trauma and to sexual trauma were significantly associated with PHQ-A, GAD-7, and CHRT-SR scores. The number of trauma exposure categories was associated with increased levels of anxiety and depression; however, only exposure to interpersonal or sexual trauma was associated with more suicidality. Clinicians should assess trauma exposure in patients seeking psychiatric care, especially for interpersonal and sexual trauma, which may be predictive of increased risk for suicidality in depressed youth. Future work should disentangle the effects of specific trauma types from multiple trauma exposure.

The Association between Adverse Childhood and Adulthood Experiences, Social Isolation, Loneliness, and Depression among Young Adults in South Korea

This study examined the association between social isolation, loneliness, and depressive symptoms among young adults in South Korea after controlling for sociodemographic variables, adverse child and adult experiences, and perceived health status. The researcher analyzed the data of 2014 young adults aged 18-34 years from the Youth Social Economic Survey using hierarchical multiple regression analysis conducted with IBM SPSS Statistics 28.0. Among the sociodemographic variables, sex, education, and household income were significantly related to depressive symptoms. Females reported higher levels of depressive symptoms than males, and those attending college or having a college (or higher) degree reported lower levels of depressive symptoms than those with a high-school diploma or lower. Higher household income was associated with lower levels of depressive symptoms. Perceived health status was negatively associated with depressive symptoms, while adverse childhood and adulthood experiences, social isolation, and loneliness were positively associated with it. Among the major independent variables, loneliness was most strongly related to depressive symptoms, whereas social isolation had the weakest relevance to it. The prediction model proposed explained 32.7% of the variance in depressive symptoms and was considered good. Therefore, focusing on loneliness may be more important than focusing on social isolation to prevent and deal with depressive symptoms among young adults.