It is interesting to note that overall exposure to traumatic events did not predict a lower rate of antidepressant treatment response. It was abuse in particular that predicted this outcome. Childhood sexual, physical, and emotional abuse predicted poorer response and remission to antidepressant treatment, especially if the abuse occurred at age 7 years or younger. The researchers suggest that clinical management of depression include screening for childhood trauma to identify individuals who may not respond to initial antidepressant treatment and may need alternative therapy.
Maternal childhood abuse and offspring depression
Roberts and colleagues4 investigated the relationship between maternal childhood abuse and depressive symptoms in adolescent and adult offspring. Data were obtained from 2 large longitudinal cohorts of women (N = 8882) and their offspring (N = 11,402). Maternal history of abuse included physical, emotional, and sexual abuse. Depressive symptoms in offspring were assessed with depression scales. The investigators also obtained information about potential mediators of a relationship between maternal childhood abuse and offspring depression. Variables examined included maternal mental health, family characteristics (income, education, family structure), and offspring experience of abuse.
Close to three-quarters (73.9%) of the offspring had mothers who reported some exposure to childhood physical, emotional, or sexual abuse. Offspring of mothers who experienced childhood abuse had an elevated rate of high depressive symptoms from age 12 to 31 years. Compared with offspring of mothers who were not exposed to abuse, those of mothers exposed to childhood abuse were at greater risk for persistence of high depressive symptoms throughout adolescence and young adulthood. Offspring of mothers who had been severely abused were more than 1.5 times more likely to have high depressive symptoms and had approximately 2.5 times the risk of persistent depressive symptoms compared with offspring of mothers who had not been abused.
What accounts for the association between maternal childhood abuse and risk of high depressive symptoms in the offspring? Maternal mental health accounted for 20.9%; family characteristics, 0.3%; and offspring’s exposure to abuse, 30.3%. The researchers recommend screening for childhood abuse in pregnant women and mothers with young children so that interventions can be provided to decrease the likelihood of depression in their offspring.
Clinicians routinely inquire about exposure to abuse when they evaluate children and adolescents. These recent studies provide compelling data about the adverse effects of childhood trauma on adult outcomes—including higher rates of depression and suicidality, lower response rates to antidepressants, and higher risk of depressive symptoms in offspring compared with adults who had no childhood trauma. Adults, as well as children and adolescents, should be screened for a history of childhood abuse in order to provide appropriate interventions.
1. Fuller-Thomson E, Baird SL, Dhrodia R, Brennenstuhl S. The association between adverse childhood experiences (ACEs) and suicide attempts in a population-based study. Child Care Health Dev. 2016; 42:725-734.
2. Klomek AB, Sourander A, Elonheimo H. Bullying by peers in childhood and effects on psychopathology, suicidality, and criminality in adulthood. Lancet Psychiatry. 2015;31:930-941.
3. Williams LM, Debattista C, Duchemin AM, et al. Childhood trauma predicts antidepressant response in adults with major depression: data from the randomized International Study to Predict Optimized Treatment for Depression. Transl Psychiatry. 2016;6:e799.
4. Roberts AL, Chen Y, Slopen N, et al. Maternal experience of abuse in childhood and depressive symptoms in adolescent and adult offspring: a 21-year longitudinal study. Depress Anxiety. 2015;32:709-719.