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Abstract
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In The Lancet Psychiatry, the Childhood Trauma Meta-Analysis Study Group reported that individuals with major depressive disorder with or without a history of childhood maltreatment had similar symptom improvement after pharmacological or psychotherapeutic treatments. Furthermore, individuals with depression and a history of childhood maltreatment had more severe symptoms both at baseline and after treatment. In their Article they conclude that "evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder regardless of childhood trauma status." We want to highlight some important methodological limitations of this research and offer an alternative interpretation of the data.
How confident can we be about the findings? As acknowledged by the authors, nearly half (25 [46%]) of the 54 studies identified in their search were not included in the meta-analysis because the original trial authors did not provide relevant data. The authors claimed that "previous meta-analyses did not examine whether adults with depression and childhood trauma benefit less from active treatment relative to a control condition" but also referenced our 2012 paper on this topic. In a random-effects meta-analysis of ten depression trials with 15 active treatment groups (with 3098 adult and adolescent participants), we found that individuals with a history of childhood maltreatment were more likely to show lack of response or remission to pharmacotherapy, psychotherapy, or combination treatment compared with individuals without a history of childhood maltreatment (odds ratio [OR] 1·43 [95% CI 1·11-1·83; heterogeneity Q 24·77; df 14; p=0·037). The meta-analyses by the Childhood Trauma Meta-Analysis Study Group omitted all but one of the studies included in our meta-analysis. Because of the significant heterogeneity in our meta-analysis, we ran sensitivity analyses to test outcomes for different treatment types and found that combined psychotherapy and pharmacotherapy had the greatest outcome differential between individuals with depression with and without a history of maltreatment (OR 1·90 [95% CI 1·40-2·58). The meta-analyses by the Childhood Trauma Meta-Analysis Study Group included only one study focusing on combined psychotherapy and pharmacotherapy that was published after our search period, whereas we had included five such studies in our paper.2
Therefore, whether or not the studies included in the meta-analyses adequately represent the published literature is unclear.
Additionally, if the findings are correct, how should they be interpreted? Individuals with a history of childhood
Language: en |