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Childhood Trauma and Depression

Childhood Trauma and Depression

Prevalence & Treatment Response

Research has demonstrated that childhood trauma is one of the risk factors contributing to depression as a response to stressors experienced later in life (Heim et al., 2008). In one study, nearly 76% of participants with depression reported experiencing childhood trauma, with 37% experiencing multiple types of trauma (Negele et al., 2015).

Genetics and environment interact such that childhood trauma increases risk of developing depression even more for people with polygenic risk factors, which are multiple genes tied to an increased prevalence of depression (Peyrot et al., 2018). Whether trauma is in a person’s history may impact which types of treatments are most effective in managing their depressive symptoms. For example, research suggests that antidepressants are less effective than psychotherapy in treating trauma survivors’ depression, while a combination of antidepressants and psychotherapy is only slightly more effective (Nemeroff et al., 2005). More recent research has confirmed these findings and that response to antidepressants is poorer in adults who reported a history of childhood trauma (Williams et al., 2016). However, the existence of conflicting findings is of note. For example, a study differentiating between participants who had experienced no trauma, experienced trauma but no abuse, had experienced sexual abuse, and had experienced physical abuse found no treatment differences when comparing effectiveness of fluoxetine, cognitive behavior therapy, and a combination of both treatments (Lewis et al., 2010). 

Physiological Alterations 

Depression has been found to correlate with a number of changes in and between resting state networks in the brain, which may provide some explanation for a  neurobiological basis of depression (Yu et al., 2019).  In addition to alterations in brain function, trauma results in physical changes in the body, including lowering the threshold for the neuroendocrine stress response, glucocorticoid resistance, increased central corticotropin-releasing factor activity, increased immune system activity, and reduction in the volume of the hippocampus, a structure in the brain tied to functions related to memory. Similar physiological changes have been found to correlate with depression (Heim et al, 2008). Depression and trauma both involve changes in neuroplasticity and inflammatory pathways (Cattaneo et al., 2015). Interestingly, one study found that while participants with depression who had experienced childhood trauma demonstrated a reduced cortisol response, participants with depression without a trauma history experienced an increased cortisol response. This suggests that trauma alone does not sufficiently explain susceptibility to developing depression (Suzuki et al., 2014). Smaller hippocampal volume was found in participants with depression who had experienced childhood physical or sexual abuse as compared with nonabused depressed participants (18% smaller) and healthy participants with neither depression nor an abuse history (15% smaller) (Vythilingam et al., 2002)

Type, Intensity, and Frequency of Trauma 

A review of the literature found about 18% of women and 5% of men who reported experiencing sexual abuse as children were diagnosed with depression as adults (Hill, 2003). Additionally, greater severity of trauma measured by the number of  multiple categories of abuse (i.e., physical, sexual, emotional) experienced by participants corresponded with  depressive symptom severity (Negele et al., 2015). Overall severity of trauma as well as severity within specific domains of trauma also correlated with severity of depression (Humphreys et al., 2020). Similarly, another study found that chronicity of depression correlated with frequency of traumatic events, with an increased number of traumatic events linked to increased duration of depression (Wiersma et al., 2009). Some types of abuse demonstrate a stronger association with depression. For example, one study found the strongest relationships between emotional abuse and depression. Following this in order of strength of relationship to depression was emotional neglect, sexual abuse, domestic violence, and physical abuse (Mandelli et al., 2015). However, possessing skills in regulating emotions may soften the impact of childhood trauma. Specifically, willingness to confront situations that elicit negative emotions correlated with both chronicity and severity of depression in participants diagnosed with major depressive disorder (Hopfinger et al., 2016). The current research certainly points to the complexity of depression and trauma, with a number of moderating and mediating factors as well as individual factors that impact treatment outcome.

References

Cattaneo, A., Macchi, F., Plazzotta, G., Veronica, B., Bocchio-Chiavetto, L., Riva, M. A., & Pariante, C. M. (2015). Inflammation and neuronal plasticity: a link between childhood trauma and depression pathogenesis. Frontiers in Cellular Neuroscience, 9(40). https://doi.org/10.3389/fncel.2015.00040

Heim, C., Newport, D. J., Mletzko, T., Miller, A. H., & Nemeroff, C. B. (2008). The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology, 33(6), 693–710. https://doi.org/10.1016/j.psyneuen.2008.03.008

Hill, J. (2003). Childhood trauma and depression. Current Opinion in Psychiatry, 16(1). https://journals.lww.com/co-psychiatry/Abstract/2003/01000/Childhood_trauma_and_depression.2.aspx

Hopfinger, L., Berking, M., Bockting, C. L., & Ebert, D. D. (2016). Emotion regulation mediates the effect of childhood trauma on depression. Journal of Affective Disorders, 198, 189–197. https://doi.org/10.1016/j.jad.2016.03.050

Humphreys, K. L., LeMoult, J., Wear, J. G., Piersiak, H. A., Lee, A., & Gotlib, I. H. (2020). Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire. Child Abuse & Neglect, 102, 104361. https://doi.org/10.1016/j.chiabu.2020.104361

Lewis, C. C., Simons, A. D., Nguyen, L. J., Murakami, J. L., Reid, M. W., Silva, S. G., & March, J. S. (2010). Impact of childhood trauma on treatment outcome in the Treatment for Adolescents with Depression Study (TADS). Journal of the American Academy of Child and Adolescent Psychiatry, 49(2), 132–140. https://doi.org/10.1097/00004583-201002000-00007

Mandelli, L., Petrelli, C., & Serretti, A. (2015). The role of specific early trauma in adult depression: A meta-analysis of published literature. Childhood trauma and adult depression. European Psychiatry, 30(6), 665–680. https://doi.org/10.1016/j.eurpsy.2015.04.007

Negele, A., Kaufhold, J., Kallenbach, L., & Leuzinger-Bohleber, M. (2015). Childhood Trauma and Its Relation to Chronic Depression in Adulthood. Depression Research and Treatment, 2015, 650804. https://doi.org/10.1155/2015/650804

Peyrot, W. J., Milaneschi, Y., Abdellaoui, A., Sullivan, P. F., Hottenga, J. J., Boomsma, D. I., & Penninx, B. W. (2014). Effect of polygenic risk scores on depression in childhood trauma. The British Journal of Psychiatry, 205(2), 113–119. https://doi.org/10.1192/bjp.bp.113.143081

Vythilingam, M., Heim, C., Newport, J., Miller, A. H., Anderson, E., Bronen, R., Brummer, 

M., Staib, L., Vermetten, E., Charney, D. S., Nemeroff, C. B., & Bremner, J. D. (2002). Childhood trauma associated with smaller hippocampal volume in women with major depression. The American Journal of Psychiatry, 159(12), 2072–2080. https://doi.org/10.1176/appi.ajp.159.12.2072

Wiersma, J. E., Hovens, J. G., van Oppen, P., Giltay, E. J., van Schaik, D. J., Beekman, A. T., & Penninx, B. W. (2009). The importance of childhood trauma and childhood life events for chronicity of depression in adults. The Journal of Clinical Psychiatry, 70(7), 983–989. https://doi.org/10.4088/jcp.08m04521

Williams, L. M., Debattista, C., Duchemin, A. M., Schatzberg, A. F., & Nemeroff, C. B. (2016). Childhood trauma predicts antidepressant response in adults with major depression: Data from the randomized international study to predict optimized treatment for depression. Translational Psychiatry, 6(5), e799. https://doi.org/10.1038/tp.2016.61

Yu, M., Linn, K. A., Shinohara, R. T., Oathes, D. J., Cook, P. A., Duprat, R., Moore, T. M., Oquendo, M. A., Phillips, M. L., McInnis, M., Fava, M., Trivedi, M. H., McGrath, P., Parsey, R., Weissman, M. M., & Sheline, Y. I. (2019). Childhood trauma history is linked to abnormal brain connectivity in major depression. Proceedings of the National Academy of Sciences of the United States of America, 116(17), 8582–8590. https://doi.org/10.1073/pnas.1900801116

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