title: Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis.
abstract: OBJECTIVE
  Evidence suggests that childhood maltreatment may negatively affect not only the lifetime risk of depression but also clinically relevant measures of depression, such as course of illness and treatment outcome. The authors conducted the first meta-analysis to examine the relationship between childhood maltreatment and these clinically relevant measures of depression.
  
  
  METHODS
  The authors conducted searches in MEDLINE, PsycINFO, and Embase for articles examining the association of childhood maltreatment with course of illness (i.e., recurrence or persistence) and with treatment outcome in depression that appeared in the literature before December 31, 2010. Recurrence was defined in terms of number of depressive episodes. Persistence was defined in terms of duration of current depressive episode. Treatment outcome was defined in terms of either a response (a 50% reduction in depression severity rating from baseline) or remission (a decrease in depression severity below a predefined clinical significance level).
  
  
  RESULTS
  A meta-analysis of 16 epidemiological studies (23,544 participants) suggested that childhood maltreatment was associated with an elevated risk of developing recurrent and persistent depressive episodes (odds ratio=2.27, 95% confidence interval [CI]=1.80–2.87). A meta-analysis of 10 clinical trials (3,098 participants) revealed that childhood maltreatment was associated with lack of response or remission during treatment for depression (odds ratio=1.43, 95% CI=1.11–1.83). Meta-regression analyses suggested that the results were not significantly affected by publication bias, choice of outcome measure, inclusion of prevalence or incidence samples, study quality, age of the sample, or lifetime prevalence of depression.
  
  
  CONCLUSIONS
  Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression.
authors.affiliation: King's College London, Institute of Psychiatry, MRC Social, Genetic, and Developmental Psychiatry Research Centre, UK.
authors.forename: Valentina
authors.initials: V
authors.lastname: Nanni
authors.forename: Rudolf
authors.initials: R
authors.lastname: Uher
authors.forename: Andrea
authors.initials: A
authors.lastname: Danese
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology / Q000706:statistics & numerical data; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data; D016001:Confidence Intervals; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D004358:Drug Therapy / Q000379:methods*; D016021:Epidemiologic Studies; D017050:Episode of Care; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000928:Antidepressive Agents