Childhood neglect and abuse as predictors of antidepressant response in adult depression.
BACKGROUND
Childhood neglect and abuse are recognized as risk factors for depression, but are not often studied as predictors of treatment response in depression.


METHODS
Clinically depressed outpatients (n=195) were asked about childhood experiences before beginning a randomized antidepressant trial with either fluoxetine or nortriptyline. Three treatment outcomes were measured: Adequate trial, six-week response and two months sustained recovery.


RESULTS
Patients reporting low paternal care (paternal neglect), as measured by the Parental Bonding Instrument (PBI), were less likely to complete an adequate six-week trial of medication. Patients who reported high maternal protection (maternal overprotection) on the PBI had poorer treatment response in the short-term at six weeks, and longer term, for two months of sustained recovery. However, abuse, whether sexual, physical, or psychological in nature, did not predict treatment response.


CONCLUSIONS
The experience of having a neglectful father or an overprotective mother was more predictive of response to treatment for depression than abuse, suggesting that the quality of ongoing intra-familial relationships has a greater impact on treatment outcomes for depression than experiences of discrete abuse in childhood.
Johnstone
Jeanette M
JM
Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand. jeanette.johnstone@otago.ac.nz
Luty
Suzanne E
SE
Carter
Janet D
JD
Mulder
Roger T
RT
Frampton
Christopher M A
CM
Joyce
Peter R
PR
D000328:Adult; D017668:Age of Onset; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000523:psychology*; D002650:Child Abuse, Sexual / Q000175:diagnosis / Q000523:psychology*; D002908:Chronic Disease; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D009661:Nortriptyline / Q000009:adverse effects / Q000627:therapeutic use*; D009769:Object Attachment; D016487:Parenting / Q000523:psychology; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents; D005473:Fluoxetine; D009661:Nortriptyline