Childhood maltreatment linked to long-term depression risk and poor response to treatment

August 13, 2011

People who have experienced maltreatment as children are twice as likely to develop both multiple and long-lasting depressive episodes as those without a history of childhood maltreatment, according to a new study. The research, led by a team at King's College London Institute of Psychiatry also found that maltreated individuals are more likely to respond poorly to pharmacological and psychological treatment for depression.

The results, to be published in the American Journal of Psychiatry, have emerged from a combined analysis of 16 epidemiological studies involving more than 20,000 participants and of 10 clinical trials involving more than 3,000 participants.

Depression ranks among the most common psychiatric disorders worldwide, with one in ten children exposed to maltreatment including psychological, physical or sexual abuse or neglect. By 2020, depression is predicted to be the second leading contributor to the global burden of disease across all ages, according to the World Health Organisation. The societal impact of depression is largely accounted for by individuals who develop multiple and long-lasting depressive episodes.

Previous research has shown that maltreated individuals are more likely to show abnormalities in biological systems sensitive to psychological stress - such as the brain, the endocrine, and the immune system - both in childhood and in adult life, which could have important clinical implications.

Dr Andrea Danese, senior investigator of the study at King's says: 'Identifying those at risk of multiple and long-lasting depressive episodes is crucial from a public health perspective. The results indicate that childhood maltreatment is associated both with an increased risk of developing recurrent and persistent episodes of depression, and with an increased risk of responding poorly to treatment.

'Therefore prevention and early therapeutic interventions targeting childhood maltreatment could prove vital in helping prevent the major health burden owing to depression. Knowing that individuals with a history of maltreatment won't respond as well to treatment may also be valuable for clinicians in determining patients' prognosis.'

Dr Danese continues: 'The biological abnormalities associated with childhood maltreatment could potentially explain why individuals with a history of maltreatment respond poorly to treatment for depression.'

Individuals with a history of maltreatment are at elevated risk of mental illness throughout their lives. However, in order to understand how early experiences bring about mental illness, future research should explore biological changes associated with maltreatment before accumulation of multiple depressive episodes.

Dr Rudolf Uher, co-author of the paper, says: 'Our study has shown that antidepressant medication, psychological treatment and the combination of the two are less effective in those who have a history of childhood maltreatment. Whilst we still do not know exactly what type of treatment may improve their care, it may be that new treatments based on the biological vulnerabilities associated with childhood maltreatment could prove an exciting avenue for research.'
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The research was supported by the UK MRC Social, Genetic & Developmental Psychiatry Centre (SGDP), and the Department of Child and Adolescent Psychiatry, both at the Institute of Psychiatry, King's College London. The authors are funded by the National Alliance for Research on Schizophrenia and Depression (NARSAD/Brain and Behavior Research Fund, USA), the Italian Ministry of University and Scientific Research, and the European Commission.

CONTACT
Katherine Barnes
International Press Officer
King's College London
Email: katherine.barnes@kcl.ac.uk
Tel: +44 (0) 7850 919 019

Notes to editors:

Nanni et al., 'Childhood Maltreatment Predicts Unfavourable Course Of Illness And Treatment Outcome In Depression: A Meta-Analysis' American Journal of Psychiatry AiA:1-10

Dr Danese and Dr Uher will be available for interviews on Friday 12 August, Saturday 13 August and Monday 15 August

King's College London (www.kcl.ac.uk)

King's College London is one of the top 25 universities in the world (2010 QS international world rankings), The Sunday Times 'University of the Year 2010/11' and the fourth oldest in England. A research-led university based in the heart of London, King's has nearly 23,500 students (of whom more than 9,000 are graduate students) from nearly 140 countries, and some 6,000 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate.

King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £450 million.

King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.

King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: www.kingshealthpartners.org

King's College London

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