title: Impact of childhood trauma on the outcomes of a perinatal depression trial.
abstract: BACKGROUND
  Childhood abuse and neglect have been linked with increased risks of adverse mental health outcomes in adulthood and may moderate or predict response to depression treatment. In a small randomized controlled trial treating depression in a diverse sample of nontreatment-seeking, pregnant, low-income women, we hypothesized that childhood trauma exposure would moderate changes in symptoms and functioning over time for women assigned to usual care (UC), but not to brief interpersonal psychotherapy (IPT-B) followed by maintenance IPT. Second, we predicted that trauma exposure would be negatively associated with treatment response over time and at the two follow-up time points for women within UC, but not for those within IPT-B who were expected to show remission in depression severity and other outcomes, regardless of trauma exposure.
  
  
  METHODS
  Fifty-three pregnant low-income women were randomly assigned to IPT-B (n = 25) or UC (n = 28). Inclusion criteria included ≥ 18 years, >12 on the Edinburgh Postnatal Depression Scale, 10-32 weeks gestation, English speaking, and access to a phone. Participants were evaluated for childhood trauma, depressive symptoms/diagnoses, anxiety symptoms, social functioning, and interpersonal problems.
  
  
  RESULTS
  Regression and mixed effects repeated measures analyses revealed that trauma exposure did not moderate changes in symptoms and functioning over time for women in UC versus IPT-B. Analyses of covariance showed that within the IPT-B group, women with more versus less trauma exposure had greater depression severity and poorer outcomes at 3-month postbaseline. At 6-month postpartum, they had outcomes indicating remission in depression and functioning, but also had more residual depressive symptoms than those with less trauma exposure.
  
  
  CONCLUSIONS
  Childhood trauma did not predict poorer outcomes in the IPT-B group at 6-month postpartum, as it did at 3-month postbaseline, suggesting that IPT including maintenance sessions is a reasonable approach to treating depression in this population. Since women with more trauma exposure had more residual depressive symptoms at 6-month postpartum, they might require longer maintenance treatment to prevent depressive relapse.
authors.affiliation: School of Social Work, University of Washington, Seattle, WA 98105, USA. ngrote@u.washington.edu
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Grote
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Spieker
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Lohr
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Geibel
authors.forename: Holly A
authors.initials: HA
authors.lastname: Swartz
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Houck
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D011203:Poverty / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011614:Psychotherapy, Brief / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome