¹Poznan University of Medical Sciences, Department of Adult Psychiatry, Poznań, Poland, ²Poznan University of Medical Sciences, Department of Computer Science and Statistics, Poznań, Poland, ³University of Brescia, Department of Molecular and Translational Medicine, Brescia, Italy, ⁴National Centre for Scientific Research, 5Paris Brain Institute, Paris, France, ⁵The Barcelona Institute for Science and Technology, Centre for Genomic Regulation, Barcelona, Spain, ⁶University of Cagliari, 9Section of Psychiatry, Department of Medical Sciences and Public Health, Cagliari, Italy, ⁷Medical Research Institute, Hospital del Mar, Barcelona, Spain, ⁸University of Cagliari, Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, Cagliari, Italy, ⁹University of Münster, Department of Psychiatry, Münster, Germany

Background: Treatment resistance in major depression affects almost 30% of patients. Although one of the possible risk factors for TRD is childhood trauma, none of the several working definitions of TRD include this feature in its characteristics. The international project entitled “Toward PrecisiON Medicine for the Prediction of Treatment response in major depressive disorder through stratification of combined clinical and – omics signatures” (PROMPT) aims to clarify the relationship between early childhood trauma and the clinical course of depression and response to treatment.

Aims & Objectives: The aim of the present study was to assess the impact of early childhood trauma (CT) on the severity of depressive symptoms during major depressive disorder (MDD), as well as on clinical response and treatment outcome, including improvement and treatment response after 8 and 12 weeks of follow-up. The specific objective was to ascertain whether the methodology of calculating the Childhood Trauma Questionnaire (CTQ) scores (categorical or quantitative approach) has an impact on the results of the research and the formulation of conclusions.

Method: The study group included 168 patients from a cohort comprising Phase 2 PROMPT study. The CTQ was used to assess five types of trauma: emotional, sexual and physical abuse, and emotional and physical neglect. The Montgomery-Åsberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI) were conducted to evaluate the intensity of depressive symptoms. To evaluate the associations between childhood trauma and treatment response, analysis of covariance (ANCOVA) was performed.

Results: A quantitative but not categorical approach for CTQ score confirmed a correlation between CTQ total score, emotional abuse and emotional neglect with intensity of depressive symptoms at baseline. Specific types of trauma correlated with depression severity in MADRS at certain follow-up points. Moderate-Severe Physical Abuse (F=3.97; p=0.048) and Sexual Abuse (F=4.76, p=0.031) obtained a significant main effect on clinical response, thus proved to be factors that contributed to the lack of response to anti-depressive treatment.

Discussion & Conclusions: Early childhood trauma, especially emotional trauma, is associated with the severity of depression. Physical and sexual abuse are related with drug-resistance, with the strongest effect of physical neglect. Interaction between childhood maltreatment and depression severity determined clinical response. The initial high severity of depression results in a weaker final improvement in cases of high trauma severity.