Impact of childhood trauma on treatment outcome in the Treatment for Adolescents with Depression Study (TADS).
OBJECTIVE
The impact of childhood trauma was examined in 427 adolescents (54% girls, 74% Caucasian, mean = 14.6, SD = 1.5) with major depressive disorder participating in the Treatment for Adolescents with Depression Study (TADS).


METHODS
TADS compared the efficacy of cognitive behavioral therapy (CBT), fluoxetine (FLX), their combination (COMB), and placebo (PBO). Teens were separated into four trauma history groups: (1) no trauma; (2) trauma, no abuse; (3) physical abuse; (4), and sexual abuse. The effects of treatment and trauma history on depression severity across 12 weeks of acute treatment, as measured by the Children's Depression Rating Scale-Revised (CDRS-R), were examined.


RESULTS
A significant trauma-by-treatment-by-time interaction indicated that trauma history moderated treatment. The Week 12 primary efficacy findings previously reported by TADS were replicated in the no trauma group (n = 201): COMB = FLX > CBT = PBO. No significant differences in treatment arms were observed among the trauma, no abuse, or physical abuse group. Teens with a history of sexual abuse treated with COMB, FLX, and PBO showed significant and equivalent improvement on the CDRS-R (mean <45), whereas the mean CDRS-R for the CBT group tended to remain in the depressed range (mean >45). Baseline suicidality and self-reported depression were significantly related to a history of sexual abuse.


CONCLUSIONS
The study was limited by the level of detail regarding childhood traumatic experiences. Results are discussed in terms of the implications for treating depressed adolescents with traumatic backgrounds.Clinical Trials Registry Information: Treatment for Adolescents with Depression Study; http://www.clinicaltrials.gov, NCT00006286.
Lewis
Cara C
CC
Psychology Department, University of Oregon, Eugene, OR 97403, USA.
Simons
Anne D
AD
Nguyen
Lananh J
LJ
Murakami
Jessica L
JL
Reid
Mark W
MW
Silva
Susan G
SG
March
John S
JS
D000293:Adolescent; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000523:psychology*; D002650:Child Abuse, Sexual / Q000175:diagnosis / Q000523:psychology*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000097:blood* / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D013313:Stress Disorders, Post-Traumatic / Q000097:blood* / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine