Brief report The effect of childhood trauma on pharmacological treatment response in depressed inpatients Katie M. Douglas n , Richard J. Porter Department of Psychological Medicine, University of Otago, P.O. Box 4345, Christchurch 8140, New Zealand article info Article history: Received 8 March 2012 Received in revised form 25 May 2012 Accepted 11 June 2012 Keywords: Major depression Child abuse Remission abstract Childhood trauma and its association with pharmacological treatment response were examined in depressed inpatients. Treatment non-responders (n ¼31) reported significantly more severe trauma than treatment responders (n ¼25) and healthy controls (n ¼49), suggesting that the experience of childhood trauma in those hospitalised with depression can be detrimental to treatment success. & 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction It is well-established that childhood trauma (abuse and/or neglect) increases the risk of developing major depression in adult life (Brown et al., 1999; Kendler et al., 2004; Fergusson et al., 2008), but research examining the effect of childhood trauma on treatment response in depression is more limited. One study found psychother- apy to be more effective than antidepressant medication for treating depressed outpatients with childhood trauma (Nemeroff et al., 2003). Two studies showed that non-response to antidepressant medication was associated with childhood emotional abuse (Kaplan and Klinetob, 2000) or maternal overprotection (Johnstone et al., 2009) in depressed outpatient samples. While psychotherapy is a feasible treatment approach for outpatient depression, typical first-line treatment for inpatients with depression involves antidepressant medication. The aim of the current study was to investigate whether childhood trauma affects antidepressant treatment response in a sample of depressed inpatients. 2. Methods 2.1. Participants Inpatients admitted to Hillmorton Hospital (Christchurch, New Zealand) with a primary diagnosis of major depression according to DSM-IV criteria (American Psychiatric Association, 1994) were recruited. Exclusion criteria included current significant alcohol or substance abuse or dependence, endocrinological, neurolo- gical or chronic medical conditions, pregnancy, previous serious head injury or electroconvulsive therapy (ECT) in the 12 months prior to admission. Sixty-eight inpatients were eligible and gave consent to be part of the study; 56 inpatients remained part of the study for the required six weeks. Reasons for non-completion included: commencement of ECT (n ¼3), being lost to follow-up (n ¼4), withdrawal of consent (n ¼2), or being hospitalised with a serious physical injury (n¼1). Two further patients refused to complete the Childhood Trauma Questionnaire (CTQ). Forty-nine control participants were recruited from the general population in Christchurch with the same exclusion criteria. Additionally, controls were excluded for a personal or immediate family history of major mental illness (screened using the Mini International Neuropsychiatric Interview, M.I.N.I., Sheehan et al., 1998). The study was approved by the National Health and Disability Ethics Committee. All participants completed multiple neuropsychological assessments over six weeks. Data from this aspect of the study are published elsewhere (Douglas and Porter, 2010; Douglas et al., 2011, 2012). 2.2. Measures Clinical assessment was conducted within five days of admission to hospital for depressed patients. The Montgomery–Asberg Depression Rating Scale (MADRS; Montgomery and Asberg, 1979) measured depression severity and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I; First et al. (1998)) assessed psychiatric comorbidity. Six weeks after baseline clinical assessment, the MADRS was repeated to determine treatment response ( 450% reduction in MADRS scores over the six-week study). Patients were treated as deemed appropriate by the treating psychiatrists. Depressed and healthy control groups completed the CTQ (Bernstein et al., 1994), a retrospective measure of adverse childhood events. This well-validated, self-report questionnaire contains 28 items which are divided into five subscales: emotional, physical and sexual abuse, and emotional and physical neglect. As the CTQ surveys sensitive occurrences, the depressed group completed it at six weeks, when they were likely to be less depressed and less overwhelmed from hospitalisation. 2.3. Statistical analysis Statistical analyses were performed using PASW (Predictive Analytic Software) Statistics 18 (SPSS, 2010). All variables were found to be normally distributed. For Contents lists available at SciVerse ScienceDirect journal homepage: www.elsevier.com/locate/psychres Psychiatry Research 0165-1781/$ - see front matter & 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.psychres.2012.06.015 n Corresponding author. Tel.: þ64 3 3720400; fax: þ64 3 3720407. E-mail address: katie.douglas@otago.ac.nz (K.M. Douglas). Psychiatry Research 200 (2012) 1058–1061