|
Abstract
|
We thank Andrea Danese and Rudolf Uher for their interest in our Article and for raising important questions regarding the confidence and interpretation of our findings. In our systematic review and meta-analysis, we found that adults with major depressive disorder with and without a history of childhood trauma had significant and similar symptom improvement after first-line pharmacological and psychotherapeutic treatments.
We agree and acknowledge in our Article that selection bias is an important limitation of our study and could be one of the explanations for inconsistencies with findings of previous meta-analyses that found worse outcomes (lower response or remission) after treatment for depression in patients with childhood trauma than in those without childhood trauma. Indeed, 46% of studies (most of which were done before 2014) identified in our meta-analysis could not provide us with the data we needed for our meta-analysis because the study authors were either unreachable or the original data were unavailable. Hence, we were only able to include a few studies from previous meta-analyses (eg, only one study from the meta-analysis by Nanni and colleagues could be included). Although this is an inherent methodological limitation, we screened multiple sources and included many clinical trials in addition to the ones identified via bibliographical databases. Therefore, much of the data came from trials that did not explicitly focus on the effect of childhood trauma, reducing the risk of selection and publication biases and probably providing a broader overview of recent findings than previous meta-analyses. As mentioned by Danese and Uher, and noted in our Article, only one study in our meta-analysis focused on combined psychotherapy and pharmacotherapy. Thus, we could not compare combination treatment to monotherapy for individuals with and without childhood trauma and we were careful not to draw conclusions about it. Nevertheless, we must highlight that, in line with previous meta-analyses, we did not observe a significant difference in outcome success between psychotherapy and pharmacotherapy. Although a meta-analysis by Nanni and colleagues showed that combination treatment had the greatest outcome differential between individuals with depression with and without childhood trauma, no formal moderation analysis was done, and the reported 95% CIs around odds ratio (OR) were overlapping, suggesting no significant difference between treatment approaches (OR 1·12 [0·68-1·85] for psychotherapy; 1·26 [1·01-1·56] for pharmacotherapy; and 1·90 [1·40-2·58] for combined therapy). Hence, we would not have expected a significant difference between the three treatment types. Moreover, to our knowledge, previous meta-analyses (including the one by Nanni and colleagues ) did not examine whether adults with depression and childhood trauma benefited less from active treatment than a control condition (ie, placebo, waitlist, or care as usual), or how this controlled treatment effect differed between patients with and without a history of childhood trauma; thus, in our Article we cited the study by Nanni and colleagues when discussing this matter. Overall, we believe that our meta-analysis extends previous findings and represents the current literature as adequately as was possible.
Our findings showed that individuals with major depressive disorder and childhood trauma were more severely depressed at the start and end of treatment, but had significant and similar symptom improvement compared with individuals with major depressive disorder without childhood trauma...
Language: en |