The relationship between childhood trauma history and the psychotic subtype of major depression

Prevalence of co-occurring severe depression and psychotic symptoms in college students and its relationship with childhood maltreatment

BACKGROUND

It has been demonstrated that childhood maltreatment (CM) is associated with an increased risk of depression and psychotic symptoms. However, there is still a lack of studies on the prevalence of co-occurring severe depression and psychotic symptoms (CSDPS) and the association between CM and CSDPS among college students.

OBJECTIVE

We aim to investigate the prevalence and demographic distribution of CSDPS among Chinese college students and to examine its relationship with CM.

PARTICIPANTS AND SETTING

A total of 7351 college students aged 18 and above completed the survey. Finally, 6854 valid questionnaires were included for further analysis.

METHODS

The Childhood Trauma Questionnaire and the item for witnessing domestic violence were used to assess the CM. The Prodromal Questionnaire-16 and the depression subscale of the Depression Anxiety and Stress-21 scale were used to assess psychotic symptoms and depressive symptoms.

RESULTS

The prevalence of CSDPS was 1.47 % among the college students. The multivariate logistic regression analysis showed that emotional abuse and emotional neglect were associated with an increased risk of CSDPS (all p < 0.05). The risk of CSDPS was dramatically increased for individuals who had experienced ≥3 types of CM (OR = 22.929, p < 0.001), as compared to those who had experienced 1-2 types of CM (OR = 4.452, p < 0.001) and those without the experience of CM.

CONCLUSION

CM was found to be associated with an increased risk of CSDPS among the college students. Notably, experiencing more types of CM was also associated with a higher risk of CSDPS.

Psychotic symptoms and neurocognition among patients with major depressive disorder: A chained mediation model of depressive symptoms and socio-occupational functioning

BACKGROUND

Depressive symptom and psychotic symptom have been identified as risk factors for impaired socio-occupational functioning in patients with major depressive disorder (MDD), while neurocognitive functioning is considered to be a potential protective factor against socio-occupational functioning. Nevertheless, little is known about the complex relationship among these factors in patients with MDD. The purpose of this research was to explore whether the relationship between depressive symptom severity and social-occupational functioning is mediated by neurocognitive functioning and psychotic symptom severity in MDD patients.

METHODS

A total of 659 eligible MDD patients included male and female, and their depressive symptoms and psychotic symptoms at baseline were assessed by the 17-item Hamilton Depression Scale (HAMD-17) and The Brief Psychiatric Rating Scale (BPRS) respectively. Cognitive domains were assessed by the MATRICS Consensus Cognitive Battery (MCCB), and subjective and objective functioning were measured by the Global Assessment of Functioning (GAF).

LIMITATION

The analysis is cross-sectional, which limits causal inference.

RESULT

(1) The correlation between depressive symptoms and thought disturbance was positive (r = 0.125, p = 0.001), whereas the correlations with visual learning and memory (r = -0.146, p < 0.001) and socio-occupational functioning (r = -0.175, p < 0.001) were negative. (2) Depressive symptoms mainly affect the socio-occupational functioning of MDD patients via three indirect effects: the single mediating effect of psychotic symptoms and neurocognitive functioning, and the chain mediating effect of psychotic symptoms and neurocognitive functioning.

CONCLUSIONS

The results suggest that the relationship between depressive symptom severity and socio-occupational functioning in MDD patients is partially mediated by psychotic symptom severity and neurocognitive functioning.

Evaluation of brain structure and metabolism in currently depressed adults with a history of childhood trauma

Structural differences in the dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), hippocampus, and amygdala were reported in adults who experienced childhood trauma; however, it is unknown whether metabolic differences accompany these structural differences. This multimodal imaging study examined structural and metabolic correlates of childhood trauma in adults with major depressive disorder (MDD). Participants with MDD completed the Childhood Trauma Questionnaire (CTQ, n = 83, n = 54 female (65.1%), age: 30.4 ± 14.1) and simultaneous positron emission tomography (PET)/magnetic resonance imaging (MRI). Structure (volume, n = 80, and cortical thickness, n = 81) was quantified from MRI using Freesurfer. Metabolism (metabolic rate of glucose uptake) was quantified from dynamic ¹⁸F-fluorodeoxyglucose (FDG)-PET images (n = 70) using Patlak graphical analysis. A linear mixed model was utilized to examine the association between structural/metabolic variables and continuous childhood trauma measures while controlling for confounding factors. Bonferroni correction was applied. Amygdala volumes were significantly inversely correlated with continuous CTQ scores. Specifically, volumes were lower by 7.44 mm³ (95% confidence interval [CI]: -12.19, -2.68) per point increase in CTQ. No significant relationship was found between thickness/metabolism and CTQ score. While longitudinal studies are required to establish causation, this study provides insight into potential consequences of, and therefore potential therapeutic targets for, childhood trauma in the prevention of MDD. This work aims to reduce heterogeneity in MDD studies by quantifying neurobiological correlates of trauma within MDD. It further provides biological targets for future interventions aimed at preventing MDD following trauma. To our knowledge, this is the first simultaneous positron emission tomography (PET) and magnetic resonance imaging (MRI) study to assess both structure and metabolism associated with childhood trauma in adults with MDD.

Childhood trauma and its impact on depressive and anxiety symptomatology in adulthood: A 6-year longitudinal study

BACKGROUND

Childhood trauma (CT) is a risk factor for depressive and anxiety disorders. However, whether CT is more strongly linked to specific clinical features of these disorders remains inconclusive. The current study comprehensively examined cross-sectional and longitudinal associations between CT and depressive/anxiety symptomatology in a large adult sample with current and remitted depressive and/or anxiety disorders.

METHODS

Baseline (n = 1803), 2-year (n = 1735), 4-year (n = 1585), and 6-year follow-up (n = 1475) data from the Netherlands Study of Depression and Anxiety were used. CT (emotional neglect, emotional/physical/sexual abuse) was assessed at baseline, while depressive/anxiety symptomatology with relevant dimensions (e.g., mood/cognitive, melancholic, general distress, and somatic depression) was assessed at each wave using self-reported questionnaires. Linear regressions and linear mixed models determined cross-sectional and longitudinal associations.

RESULTS

Individuals with CT, especially, severe CT, compared to those without CT, had significantly higher scores in overall depressive symptomatology (Cohen's d = 0.674), mood/cognitive depression (d = 0.691), melancholic depression (d = 0.587), general distress (d = 0.561), and somatic depression severity (d = 0.549). Differences were lower, but still highly significant for anxiety (d = 0.418), worry (d = 0.362), and fear/phobic symptomatology (d = 0.359). Effects were consistent across CT types and maintained over six years.

LIMITATIONS

Retrospectively-reported CT.

CONCLUSIONS

CT is a risk factor for depressive and anxiety symptomatology across all dimensions and enduring over multiple years. Screening for CT is essential to identify individuals at risk for more severe and chronic manifestations of affective disorders.

Childhood maltreatment and its role in the development of pain and psychopathology

Childhood maltreatment represents a form of trauma capable of altering fundamental neurobiological properties and negatively impacting neurodevelopmental processes. An outcome of childhood maltreatment is the emergence of psychopathology, which might become evident during childhood or adolescence, but might also project into adulthood. In this Review, we propose a biobehavioural framework in which childhood maltreatment and the associated aberrant neurobiological mechanisms and behavioural processes additionally lead to the onset of altered pain processing and, ultimately, the existence of pain syndromes. Considering that subpopulations of maltreated children show preserved function and minimal psychiatric or pain symptoms, compensatory mechanisms-perhaps instilled by robust psychosocial support systems-are also discussed. We present validated tools and experimental methods that could facilitate better comprehension of the interactions between childhood maltreatment, psychopathology, and pain. Such tools and approaches can in parallel be implemented to monitor abnormal pain-related processes and potentially guide early intervention strategies in cases of childhood maltreatment.

Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment

Psychotic depression was initially considered to be at one end of a continuum of severity of major depression. Subsequent experience demonstrated that psychosis is an independent trait that may accompany mood disorders of varying severity. While much has been learned about the impact of severe mood congruent delusions and hallucinations on the course and treatment response of depression, less is known about fleeting or mild psychosis, mood incongruent features, or psychotic symptoms that reflect traumatic experiences. Acute treatment of psychotic unipolar depression generally involves the combination of an antidepressant and an antipsychotic drug or electroconvulsive therapy. There is inadequate information about maintenance treatment of unipolar psychotic depression and acute and chronic treatment of psychotic bipolar disorder. Decision-making therefore still must rely in part on clinical experience.

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

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.

Clinical characteristics and sociodemographic features of psychotic major depression

BACKGROUND

Psychotic major depression (PMD) is a subtype of depression with a poor prognosis. Previous studies have failed to find many differences between patients with PMD and those with non-psychotic major depression (NMD) or schizophrenia (SZ). We compared sociodemographic factors (including season of conception) and clinical characteristics between patients with PMD, NMD, and schizophrenia. Our aim was to provide data to help inform clinical diagnoses and future etiology research.

METHODS

This study used data of all patients admitted to Shandong Mental Health Center from June 1, 2016 to December 31, 2017. We analyzed cases who had experienced an episode of PMD (International Classification of Diseases, Tenth Revision codes F32.3, F33.3), NMD (F32.0-2/9, F33.0-2/9), and SZ (F20-20.9). Data on sex, main discharge diagnosis, date of birth, ethnicity, family history of psychiatric diseases, marital status, age at first onset, education, allergy history, and presence of trigger events were collected. Odds ratios (OR) were calculated using logistic regression analyses. Missing values were filled using the k-nearest neighbor method.

RESULTS

PMD patients were more likely to have a family history of psychiatric diseases in their first-, second-, and third-degree relatives ([OR] 1.701, 95% confidence interval [CI] 1.019-2.804) and to have obtained a higher level of education (OR 1.451, 95% CI 1.168-1.808) compared with depression patients without psychotic features. Compared to PMD patients, schizophrenia patients had lower education (OR 0.604, 95% CI 0.492-0.741), were more often divorced (OR 3.087, 95% CI 1.168-10.096), had a younger age of onset (OR 0.934, 95% CI 0.914-0.954), less likely to have a history of allergies (OR 0.604, 95% CI 0.492-0.741), and less likely to have experienced a trigger event 1 year before first onset (OR 0.420, 95% CI 0.267-0.661). Season of conception, ethnicity, and sex did not differ significantly between PMD and NMD or schizophrenia and PMD.

CONCLUSIONS

PMD patients have more similarities with NMD patients than SZ patients in terms of demographic and clinical characteristics. The differences found between PMD and SZ, and PMD and NMD correlated with specificity of the diseases. Furthermore, allergy history should be considered in future epidemiological studies of psychotic disorders.

Early Adverse Stress and Depressive and Bipolar Disorders: A Systematic Review and Meta-Analysis of Treatment Interventions

Introduction: A significant proportion of adults with depressive or bipolar disorders exposed to early adverse stressors do not adequately respond to standard treatments. This review aimed at synthesizing the evidence on the effectiveness of treatment interventions for depressive or bipolar disorders in adult individuals (aged 18 years or more) exposed to adverse stress early in life. Methods: Systematic review and meta-analysis including experimental and quasi-experimental published studies indexed in CINAHL, EMBASE, PubMed, and Web of Science databases and/or in reference lists. Data management and critical appraisal (with the Study Quality Assessment Tools) was conducted independently by multiple researchers. A quality-effects model for meta-analysis was used for data synthesis and publication bias was assessed using the Doi plot and LFK index. The main outcome was short-term reductions in depressive symptoms. Results: Eight randomized controlled trials, three controlled before-and-after (pre-post) studies, and three uncontrolled before-and-after studies were included. Studies lacked bipolar disorder patients. Unclear randomization procedures and reporting of blinded outcome assessor, and limited use of intention-to-treat analysis, were relevant potential sources of bias. Meta-analyses indicated that psychological, pharmacological, and combined interventions were effective in reducing depressive symptoms in the short- (Cohen's d = -0.55, 95% CI -0.75 to -0.36, I ² = 0%) and mid-term (Cohen's d = -0.66, 95% CI -1.07 to -0.25, I ² = 65.0%). However, a high risk of publication bias was detected for these outcomes. A small number of studies, with mixed results, reported interventions with long-term improvements in depressive symptomatology, and short- and mid-term response to treatment and remission. Conclusion: Despite the well-documented long-lasting, negative, and costly impact of early adverse stressors on adult psychopathology, evidence on treatment alternatives remains scant. Trauma-focused treatment interventions-whether psychological interventions alone or in combination with pharmacotherapy-may have the potential to reduce the severity of depressive symptom in adults who were exposed to early adverse stress. Findings must be interpreted with considerable caution, as important study and outcome-level limitations were observed and gray literature was not considered in this systematic review and meta-analysis.

Exploring the impact of trauma type and extent of exposure on posttraumatic alterations in 5-HT1A expression

The long-term behavioral, psychological, and neurobiological effects of exposure to potentially traumatic events vary within the human population. Studies conducted on trauma-exposed human subjects suggest that differences in trauma type and extent of exposure combine to affect development, maintenance, and treatment of a variety of psychiatric syndromes. The serotonin 1-A receptor (5-HT1A) is an inhibitory G protein-coupled serotonin receptor encoded by the HTR1A gene that plays a role in regulating serotonin release, physiological stress responding, and emotional behavior. Studies from the preclinical and human literature suggest that dysfunctional expression of 5-HT1A is associated with a multitude of psychiatric symptoms commonly seen in trauma-exposed individuals. Here, we synthesize the literature, including numerous preclinical studies, examining differences in alterations in 5-HT1A expression following trauma exposure. Collectively, these findings suggest that the impact of trauma exposure on 5-HT1A expression is dependent, in part, on trauma type and extent of exposure. Furthermore, preclinical and human studies suggest that this observation likely applies to additional molecular targets and may help explain variation in trauma-induced changes in behavior and treatment responsivity. In order to understand the neurobiological impact of trauma, including the impact on 5-HT1A expression, it is crucial to consider both trauma type and extent of exposure.

The potential role of EMDR on trauma in affective disorders: A narrative review

BACKGROUND

Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapeutic approach that has originally been developed to treat post-traumatic stress disorder (PTSD). Recently it has been suggested as a complementary therapy in a wide range of clinical conditions. In particular, affective disorders as bipolar disorder (BD) and major depressive disorder (MDD) have a higher lifetime prevalence of traumatic or stressful life events (SLEs) compared to the general population, which makes them good candidates for the application of EMDR.

METHODS

A bibliographic search on PUBMED, Scopus, and ScienceDirect of studies applying EMDR to people with a primary diagnosis of bipolar disorder (BD) and major depressive disorder (MDD) (with or without a comorbid PTSD) was conducted.

RESULTS

Literature search retrieved 15 studies, of which 3 were focused on BD and 12 on MDD. Overall, they suggest EMDR as an effective tool in reducing trauma-related but also manic and depressive symptoms, with few effect sides and high adherence rates.

LIMITATIONS

Few small studies exist with heterogeneous and not gold-standard methodology, especially for BD.

CONCLUSIONS

Overall, retrieved studies can be considered as first attempts at investigating the applicability of EMDR in affective disorders. Although far to be conclusive, preliminary evidence suggests EMDR as a useful adjunctive approach in the treatment of BD and MDD, especially when other treatments have failed. It is now the time to implement such trauma-focused therapy to larger samples of patients using more rigorous methods.

Additional Insights into the Relationship Between Brain Network Architecture and Susceptibility and Resilience to the Psychiatric Sequelae of Childhood Maltreatment

Childhood maltreatment is associated with increased risk for psychiatric and substance use disorders. However, some maltreated individuals appear resilient to these consequences while manifesting the same array of brain changes as maltreated individuals with psychopathology. Hence, a critical issue has been to identify compensatory brain alterations in these resilient individuals. We recently reported that maltreatment is associated with a more vulnerable structural brain network architecture. Resilient individuals have this same vulnerability but appeared to be able to effectively compensate due to reduced nodal efficiency (ability of a node to influence the global network) in 9 specific brain regions that moderate the relationship between maltreatment and psychopathology. Following up we now report that network vulnerability increases progressively during late adolescence to plateau at about 21 years of age, which may help to explain age of onset of psychopathology. Further, we found that network vulnerability was most significantly affected by parental verbal abuse between 16-18 years of age and number of types of maltreatment during childhood. Asymptomatic individuals with no history of psychopathology had more prominent alterations in nodal efficiency than asymptomatic individuals with prior history, who specifically showed reduced nodal efficiency in right amygdala and right subcallosal gyrus. Experiencing inadequate financial sufficiency during childhood increased risk of susceptibility versus resilience by 2.98-fold (95% CI 1.49-5.97, p = 0.002) after adjusting for differences in exposure to maltreatment. Interestingly, adequate-to-higher financial sufficiency appeared to be protective and was associated with reduced nodal efficiency in the right postcentral gyrus and subcallosal gyrus 'resilience' nodes.

Early childhood and adolescent risk factors for psychotic depression in a general population birth cohort sample

BACKGROUND AND PURPOSE

In the group of severe mental disorders, psychotic depression (PD) is essentially under-researched. Knowledge about the risk factors is scarce and this applies especially to early risk factors. Our aim was to study early childhood and adolescent risk factors of PD in a representative birth cohort sample with a follow-up of up to 50 years.

METHODS

The study was carried out using the Northern Finland Birth Cohort 1966 (NFBC 1966). We used non-psychotic depression (NPD) (n = 746), schizophrenia (SZ) (n = 195), psychotic bipolar disorder (PBD) (n = 27), other psychoses (PNOS) (n = 136) and healthy controls (HC) (n = 8200) as comparison groups for PD (n = 58). We analysed several potential early risk factors from time of birth until the age of 16 years.

RESULTS

The main finding was that parents' psychiatric illness [HR 3.59 (1.84-7.04)] was a risk factor and a high sports grade in school was a protective factor [HR 0.29 (0.11-0.73)] for PD also after adjusting for covariates in the multivariate Cox regression model. Parental psychotic illness was an especially strong risk factor for PD. The PD subjects had a parent with psychiatric illness significantly more often (p < 0.05) than NPD subjects. Differences between PD and other disorder groups were otherwise small.

CONCLUSIONS

A low sports grade in school may be a risk factor for PD. Psychiatric illnesses, especially psychoses, are common in the parents of PD subjects. A surprisingly low number of statistically significant risk factors may have resulted from the size of the PD sample and the underlying heterogeneity of the etiology of PD.

Depression in Children and Adolescents Involved in the Child Welfare System

Child maltreatment presents a significant public health challenge and is strongly associated with development of depression during childhood and adolescence. Not all abused or neglected children are in the child welfare system, but most children in the foster care system have a history of maltreatment. Involvement with the child welfare system presents an additional risk for psychopathology. The role of child maltreatment and child welfare involvement in development of depression in children and adolescents is reviewed and effective treatments are discussed. Clinicians working with foster children must collaborate with care providers and other stakeholders to enhance the child's placement permanence.

Susceptibility or Resilience to Maltreatment Can Be Explained by Specific Differences in Brain Network Architecture

BACKGROUND

Childhood maltreatment is a major risk factor for psychopathology. However, some maltreated individuals appear remarkably resilient to the psychiatric effects while manifesting the same array of brain abnormalities as maltreated individuals with psychopathology. Hence, a critical aim is to identify compensatory brain alterations that enable resilient individuals to maintain mental well-being despite alterations in stress-susceptible regions.

METHODS

Network models were constructed from diffusion tensor imaging and tractography in physically healthy unmedicated 18- to 25-year-old participants (N = 342, n = 192 maltreated) to develop network-based explanatory models.

RESULTS

First, we determined that susceptible and resilient individuals had the same alterations in global fiber stream network architecture using two different definitions of resilience: 1) no lifetime history of Axis I or II disorders, and 2) no clinically significant symptoms of anxiety, depression, anger-hostility, or somatization. Second, we confirmed an a priori hypothesis that right amygdala nodal efficiency was lower in asymptomatic resilient than in susceptible participants or control subjects. Third, we identified eight other nodes with reduced nodal efficiency in resilient individuals and showed that nodal efficiency moderated the relationship between maltreatment and psychopathology. Fourth, we found that models based on global network architecture and nodal efficiency could delineate group membership (control, susceptible, resilient) with 75%, 82%, and 80% cross-validated accuracy.

CONCLUSIONS

Together these findings suggest that sparse fiber networks with increased small-worldness following maltreatment render individuals vulnerable to psychopathology if abnormalities occur in specific nodes, but that decreased ability of certain nodes to propagate information throughout the network mitigates the effects and leads to resilience.

Clinical efficacy of trauma-focused psychotherapies in treatment-resistant depression (TRD) in-patients: A randomized, controlled pilot-study

In major depressive disorder (MDD) patients, life stress events represent a risk factor for a severe, early-onset, treatment-resistant and chronic endophenotype. Treatment-resistant depression (TRD) patients who have experienced traumatic events could benefit from evidence-based trauma-focused psychotherapies. Because this topic has never been investigated, the aim of this pilot trial was to evaluate whether trauma-focused cognitive-behavioural therapy (TF-CBT) and/or eye movement desensitization and reprocessing (EMDR) can help achieve depressive symptom remission in TRD patients. We carried out a single-blind randomized controlled trial with TRD patients and we compared EMDR (N = 12) with TF-CBT (N = 10). Patients received 3 individual sessions per week over a period of 8 weeks. The symptomatological assessments were performed at 4 timepoints: baseline (T0), 4 (T4), 8 (T8) and 12 (T12) weeks. After 24 weeks, a clinical interview was carried out by phone. All TRD patients showed a significant improvement in depressive symptomatology; however, post hoc comparisons showed a significant difference between the two treatment groups, with lower depressive symptom scores in the EMDR than in the TF-CBT group at the follow-up (T12). This effect was partly maintained at 24 weeks. This pilot study suggests that evidence-based trauma-focused psychotherapies, particularly EMDR, can represent effective interventions to treat TRD patients.

Epidemiology of psychotic depression - systematic review and meta-analysis

Large amount of data have been published on non-psychotic depression (NPD), schizophrenia (SZ), and bipolar disorder, while psychotic depression (PD) as an own entity has received much smaller attention. We performed a systematic review and meta-analyses on epidemiology, especially incidence and prevalence, risk factors, and outcomes of PD. A systematic search to identify potentially relevant studies was conducted using four electronic databases and a manual search. The search identified 1764 unique potentially relevant articles, the final study included 99 articles. We found that the lifetime prevalence of PD varies between 0.35% and 1%, with higher rates in older age. Onset age of PD was earlier than that of NPD in younger samples, but later in older samples. There were no differences in gender distribution in PD v. NPD, but higher proportion of females was found in PD than in SZ or in psychotic bipolar disorder (PBD). Risk factors have rarely been studied, the main finding being that family history of psychosis and bipolar disorder increases the risk of PD. Outcomes of PD were mostly worse when compared with NPD, but better compared with SZ and schizoaffective disorder. The outcome compared with PBD was relatively similar, and somewhat varied depending on the measure of the outcome. Based on this review, the amount of research on PD is far from that of NPD, SZ, and bipolar disorder. Based on our findings, PD seems distinguishable from related disorders and needs more scientific attention.

Childhood maltreatment is associated with alteration in global network fiber-tract architecture independent of history of depression and anxiety

Childhood maltreatment is a major risk factor for psychopathology. It is also associated with alterations in the network architecture of the brain, which we hypothesized may play a significant role in the development of psychopathology. In this study, we analyzed the global network architecture of physically healthy unmedicated 18-25 year old subjects (n=262) using diffusion tensor imaging (DTI) MRI and tractography. Anatomical networks were constructed from fiber streams interconnecting 90 cortical or subcortical regions for subjects with no-to-low (n=122) versus moderate-to-high (n=140) exposure to maltreatment. Graph theory analysis revealed lower degree, strength, global efficiency, and maximum Laplacian spectra, higher pathlength, small-worldness and Laplacian skewness, and less deviation from artificial networks in subjects with moderate-to-high exposure to maltreatment. On balance, local clustering was similar in both groups, but the different clusters were more strongly interconnected in the no-to-low exposure group. History of major depression, anxiety and attention deficit hyperactivity disorder did not have a significant impact on global network measures over and above the effect of maltreatment. Maltreatment is an important factor that needs to be taken into account in studies examining the relationship between network differences and psychopathology.

Childhood trauma and dimensions of depression: a specific association with the cognitive domain

Objective:

To investigate associations between a history of childhood trauma and dimensions of depression in a sample of clinically depressed patients.

Methods:

A sample of 217 patients from a mood-disorder outpatient unit was investigated with the Beck Depression Inventory, the Hamilton Depression Rating Scale, the CORE Assessment of Psychomotor Change, and the Childhood Trauma Questionnaire. A previous latent model identifying six depressive dimensions was used for analysis. Path analysis and Multiple Indicators Multiple Causes (MIMIC) models were used to investigate associations between general childhood trauma and childhood maltreatment modalities (emotional, sexual, and physical abuse; emotional and physical neglect) with dimensions of depression (sexual, cognition, insomnia, appetite, non-interactiveness/retardation, and agitation).

Results:

The overall childhood trauma index was uniquely associated with cognitive aspects of depression, but not with any other depressive dimension. An investigation of childhood maltreatment modalities revealed that emotional abuse was consistently associated with depression severity in the cognitive dimension.

Conclusion:

Childhood trauma, and specifically emotional abuse, could be significant risk factors for the subsequent development of cognitive symptoms of major depression. These influences might be specific to this depressive dimension and not found in any other dimension, which might have conceptual and therapeutic implications for clinicians and researchers alike.

Clarifying Associations between Childhood Adversity, Social Support, Behavioral Factors, and Mental Health, Health, and Well-Being in Adulthood: A Population-Based Study

Previous studies have shown that socio-demographic factors, childhood socioeconomic status (CSES), childhood traumatic experiences (CTEs), social support and behavioral factors are associated with health and well-being in adulthood. However, the relative importance of these factors for mental health, health, and well-being has not been studied. Moreover, the mechanisms by which CTEs affect mental health, health, and well-being in adulthood are not clear. Using data from a representative sample (n = 12,981) of the adult population in Tromsø, Norway, this study examines (i) the relative contribution of structural conditions (gender, age, CSES, psychological abuse, physical abuse, and substance abuse distress) to social support and behavioral factors in adulthood; (ii) the relative contribution of socio-demographic factors, CSES, CTEs, social support, and behavioral factors to three multi-item instruments of mental health (SCL-10), health (EQ-5D), and subjective well-being (SWLS) in adulthood; (iii) the impact of CTEs on mental health, health, and well-being in adulthood, and; (iv) the mediating role of adult social support and behavioral factors in these associations. Instrumental support (24.16%, p < 0.001) explained most of the variation in mental health, while gender (21.32%, p < 0.001) explained most of the variation in health, and emotional support (23.34%, p < 0.001) explained most of the variation in well-being. Psychological abuse was relatively more important for mental health (12.13%), health (7.01%), and well-being (9.09%), as compared to physical abuse, and substance abuse distress. The subjective assessment of childhood financial conditions was relatively more important for mental health (6.02%), health (10.60%), and well-being (20.60%), as compared to mother's and father's education. CTEs were relatively more important for mental health, while, CSES was relatively more important for health and well-being. Respondents exposed to all three types of CTEs had a more than two-fold increased risk of being mentally unhealthy (RR Total Effect = 2.75, 95% CI: 2.19-3.10), an 89% increased risk of being unhealthy (RR Total Effect = 1.89, 95% CI: 1.47-1.99), and a 42% increased risk of having a low level of well-being in adulthood (RR Total Effect = 1.42, 95% CI: 1.29-1.52). Social support and behavioral factors mediate 11-18% (p < 0.01) of these effects. The study advances the theoretical understanding of how CTEs influence adult mental health, health, and well-being.

Prevalence and symptomatic correlates of interpersonal trauma in South Korean outpatients with major depressive disorder

BACKGROUND

There is growing evidence that exposure to severe interpersonal trauma (IPT) has a pivotal role in the development and manifestation of depression. However, it is not clearly understood whether patients with major depressive disorder (MDD) have specifically increased prevalence of IPT than other non-interpersonal traumatic events and whether those with IPT have unique symptom profile within depressed groups. In this study, we investigated the prevalence of past traumatic events and symptomatic features of treatment-seeking outpatients with MDD.

METHODS

A consecutive sample of 111 South Korean outpatients with MDD was recruited on their first visit to a psychiatric department of a university-affiliated hospital. Participants completed the Life Events Checklist (LEC), the Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Dissociative Experience Scale (DES) and Impact of Event Scale-Revised (IES-R). The prevalence of past traumatic events on LEC was compared to medical outpatients.

RESULTS

Compared to medical outpatients, MDD patients had significantly higher rates of IPT (physical and sexual) but not other traumatic events of non-interpersonal origin such as accidents or disaster. Compared to MDD patients without IPT (n=44, 40%), those with IPT (n=67, 60%) had higher subscale scores on hostility in SCL-90-R, as well as greater depressive and post-traumatic symptoms. However, multivariate analysis revealed that the best model to discriminate those with IPT was interaction of depressive and posttraumatic symptoms.

LIMITATIONS

Limitations include sample characteristics (treatment-seeking outpatients) and possible effects of comorbid conditions, which were not investigated.

CONCLUSIONS

Clinicians managing individuals with depressive disorder need to include the assessment of lifetime IPT and its impact on presenting symptoms.

The effects of childhood abuse on self-reported psychotic symptoms in severe mental illness: Mediating effects of posttraumatic stress symptoms

The present study examined the role of posttraumatic stress symptoms in the relationship between childhood abuse and self-reported psychotic symptoms in severe mental illness. A total of 126 patients diagnosed with major psychiatric conditions with comorbid symptoms of psychosis participated in the present study. The representative psychiatric diagnoses included schizophrenia, bipolar disorder with psychotic features, major depressive disorder with psychotic features, schizoaffective disorder, schizophreniform disorder, and delusional disorder. The Korean Child Trauma Questionnaire measured the type and degree of childhood abuse including emotional, physical, and sexual abuse. Korean version of the Impact of Event Scale-Revised assessed posttraumatic stress symptoms, and PSYC subscale of the PSY-5 Factor Scale of the MMPI-2 was used as a measure of self-reported psychotic symptoms. There was a significant relationship between childhood physical, emotional, sexual abuse and psychotic symptoms. Posttraumatic stress symptoms partially mediated the relationship between childhood abuse and psychotic symptoms. This implies that childhood abuse is significantly associated with the experience of chronic posttraumatic stress symptoms, and that such symptoms in turn increases the likelihood of experiencing psychotic symptoms. The results highlight the need for appropriate assessment and intervention concerning childhood abuse and posttraumatic stress symptoms in severe mental illness.

Impact of childhood adversities on the short-term course of illness in psychotic spectrum disorders

Accumulating evidence indicates an impact of childhood adversities on the severity and course of mental disorders, whereas this impact on psychotic disorders remains to be specified. Effects of childhood adversities on comorbidity, on symptom severity of the Positive and Negative Syndrome Scale and global functioning across four months (upon admission, 1 and 4 months after initial assessment), as well as the course of illness (measured by the remission rate, number of re-hospitalizations and dropout rate) were evaluated in 62 inpatients with psychotic spectrum disorders. Adverse experiences (of at least 1 type) were reported by 73% of patients. Patients with higher overall level of childhood adversities (n=33) exhibited more co-morbid disorders, especially alcohol/substance abuse and dependency, and higher dropout rates than patients with a lower levels of adverse experiences (n=29), together with higher levels of positive symptoms and symptoms of excitement and disorganization. Emotional and physical neglect were particularly related to symptom severity. Results suggest that psychological stress in childhood affects the symptom severity and, additionally, a more unfavorable course of disorder in patients diagnosed with psychoses. This impact calls for its consideration in diagnostic assessment and psychiatric care.

A latent class analysis of trauma based on a nationally representative sample of US adolescents

PURPOSE

Traumatic events in adolescence rarely occur in isolation. Multiple traumatic experiences are prevalent, diverse and a well-established risk factor for mental health disorders. The aim of this study was to explore and explain the heterogeneity in trauma profiles in a nationally representative sample of US adolescents.

METHOD

Using latent class analysis, data on 10,123 adolescents aged between 13 and 18 from the National Comorbidity Survey Adolescent Supplement were examined. In addition, the relationships between the emergent classes and demographic and clinical variables were explored.

RESULTS

A four-class solution was the best fit of adolescent trauma patterns, with classes labelled as low risk, sexual assault risk, non-sexual risk and high risk. When compared to the low risk class, those in the other classes were significantly more likely not to live with either biological parent, display symptoms indicative of mood and anxiety disorders, and to have higher rates of disorder comorbidity.

CONCLUSIONS

This provides evidence of four distinct groups of adolescents who have experienced a variety of traumas. Evidence demonstrates the increased risk of adolescents with a history of trauma meeting the diagnostic criteria for not only individual disorders but also comorbidity across disorder categories.

The Relation of Childhood Maltreatment to Psychotic Symptoms in Adolescents and Young Adults With Depression

This study examined the relation between a history of maltreatment and the presence of psychotic symptoms in a community sample of adolescents and young adults with major depressive disorder. One hundred and twenty-nine depressed adolescents and young adults (M = 16.02 years, 77% female, 92% White) were recruited through community advertisement and clinician referral. Clinical diagnoses and psychotic symptoms (i.e., hallucinations and delusions) were assessed using a structured diagnostic interview. Childhood maltreatment was assessed using a contextual interview and standardized rating system. Logistic regression analyses examined the relation between childhood maltreatment and psychotic symptoms. As hypothesized, individuals with psychotic symptoms were significantly more likely to report a history of severe sexual maltreatment than those without psychotic symptoms (Wald = 5.44, odds ratio = 3.86, p = .020), 95% confidence interval [1.24, 12.01]. Further, those with psychotic symptoms were more likely to report being the victims of more than one type of maltreatment than those without, χ2(2) = 6.66, p = .036 (ϕ = .23; 40% vs. 16%). Results held upon adjusting for overall level of depression symptoms. A history of severe sexual maltreatment is related to a severe presentation of major depressive disorder even in the initial onset of the syndrome in adolescence and young adulthood. These findings underscore the importance of early assessment of both depression and maltreatment history to implement interventions that have the potential to prevent the emergence of psychotic psychopathology in young people at risk.

The impact of childhood adversity on suicidality and clinical course in treatment-resistant depression

BACKGROUND

Childhood adversity is a risk factor for the development of depression and can also affect clinical course. We investigated this specifically in treatment-resistant depression (TRD).

METHODS

One hundred and thirty-seven patients with TRD previously admitted to an inpatient affective disorders unit were included. Clinical, demographic and childhood adversity (physical, sexual, emotional abuse; bullying victimization, traumatic events) data were obtained during admission. Associations between childhood adversity, depressive symptoms and clinical course were investigated.

RESULTS

Most patients had experienced childhood adversity (62%), with traumatic events (35%) and bullying victimization (29%) most commonly reported. Childhood adversity was associated with poorer clinical course, including earlier age of onset, episode persistence and recurrence. Logistic regression analyses revealed childhood adversity predicted lifetime suicide attempts (OR 2.79; 95% CI 1.14, 6.84) and childhood physical abuse predicted lifetime psychosis (OR 3.42; 95% CI 1.00, 11.70).

LIMITATIONS

The cross-sectional design and retrospective measurement of childhood adversity are limitations of the study.

CONCLUSIONS

Childhood adversity was common amongst these TRD patients and was associated with poor clinical course, psychosis and suicide attempts. Routine assessment of early adversity may help identify at risk individuals and inform clinical intervention.

Depression with psychotic features is influenced by the polymorphism of the serotonin transporter gene

INTRODUCTION

Current diagnostic classifications regard psychotic symptoms during depressive episodes as indicators of depression severity. However, growing evidence suggests that depression with psychotic symptoms (MDP) may represent a distinct subtype of depression. In the course of the search for discriminating factors we tested the hypothesis that the serotonin transporter gene (5-HTTLPR) may interact with the manifestation of psychotic symptoms in acute depression.

METHODS

112 inpatients (61 female) with a depressive episode (16 bipolar, 86 unipolar) at admission were genotyped for 5-HTTLPR variants. Psychotic symptoms und general psychopathology were evaluated comprehensively using the Manual of the Association for Methodology and Documentation in Psychiatry (Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie, 1981). For statistical analysis a chi-square test and a logistic regression model was used.

RESULTS

16 (14.3%) out of 112 patients were currently presenting with psychotic symptoms. The primary finding of our study was the higher prevalence of the s-allele of the 5-HTTLPR within the group of MDP patients (Pearson χ²=7.87; df=2; p<0.03). Secondly, in a logistic regression model, 5-HTTLPR was found to significantly contribute to the diagnosis of MDP (χ²=6.5; df=1; p=0.01). This effect was even more pronounced upon comparing only severely depressed patients with MDP patients. From a psychopathological perspective, MDP patients showed higher AMDP hostility and apathy scores but equal AMDP depression scores.

DISCUSSION

This is the first study to show an influence of 5-HTTLPR on psychotic symptoms in acutely depressed patients.

LIMITATIONS

The lack of a control group and the relatively small sample size limits the present study's findings, thus replication in a larger sample is necessary.

Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness

BACKGROUND

Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice.

OBJECTIVE

To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI.

METHODS

We conducted a systematic review of four databases (1980-2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders.

RESULTS

Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25-72%), sexual abuse 37% (range 24-49%), and posttraumatic stress disorder (PTSD) 30% (range 20-47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI.

CONCLUSIONS

Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI.

The impact of childhood sexual abuse on psychological distress among women in New Zealand

PROBLEMS

In order to better understand the long-term impact of child sex abuse, this study examined the association between women's experience of abuse, health symptoms, and psychological distress in adulthood. There is limited information about child abuse outside the United States.

METHODS

Nine hundred sixty-one women participated in a structured interview.

RESULTS

Participants who had experienced abuse (13%) were significantly more vulnerable to psychological distress in adulthood if they were younger, less satisfied with their standard of living, and resided in urban areas.

CONCLUSION

Dissemination and evaluation of therapies for the treatment of sex abuse in the New Zealand context is warranted.