title: The impact of childhood adversity on suicidality and clinical course in treatment-resistant depression.
abstract: BACKGROUND
  Childhood adversity is a risk factor for the development of depression and can also affect clinical course. We investigated this specifically in treatment-resistant depression (TRD).
  
  
  METHODS
  One hundred and thirty-seven patients with TRD previously admitted to an inpatient affective disorders unit were included. Clinical, demographic and childhood adversity (physical, sexual, emotional abuse; bullying victimization, traumatic events) data were obtained during admission. Associations between childhood adversity, depressive symptoms and clinical course were investigated.
  
  
  RESULTS
  Most patients had experienced childhood adversity (62%), with traumatic events (35%) and bullying victimization (29%) most commonly reported. Childhood adversity was associated with poorer clinical course, including earlier age of onset, episode persistence and recurrence. Logistic regression analyses revealed childhood adversity predicted lifetime suicide attempts (OR 2.79; 95% CI 1.14, 6.84) and childhood physical abuse predicted lifetime psychosis (OR 3.42; 95% CI 1.00, 11.70).
  
  
  CONCLUSIONS
  The cross-sectional design and retrospective measurement of childhood adversity are limitations of the study.
  
  
  CONCLUSIONS
  Childhood adversity was common amongst these TRD patients and was associated with poor clinical course, psychosis and suicide attempts. Routine assessment of early adversity may help identify at risk individuals and inform clinical intervention.
authors.affiliation: Division of Psychological Medicine and Psychiatry, Section of Neurobiology of Mood Disorders, Institute of Psychiatry, King's College London, 103 Denmark Hill, London SE5 8AZ, UK; The National Affective Disorder Unit, South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Tunnard
authors.forename: Lena J
authors.initials: LJ
authors.lastname: Rane
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Wooderson
authors.forename: Kalypso
authors.initials: K
authors.lastname: Markopoulou
authors.forename: Lucia
authors.initials: L
authors.lastname: Poon
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
authors.forename: Mario
authors.initials: M
authors.lastname: Juruena
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Cleare
mesh_terms: D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D017668:Age of Onset; D058445:Bullying / Q000523:psychology; D003430:Cross-Sectional Studies; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index; D013406:Suicide, Attempted / Q000523:psychology*; D016896:Treatment Outcome
keywords: Abuse; Childhood adversity; Childhood trauma; Early life stress; Refractory depression; Suicide; Treatment-resistant depression