title: The association of childhood trauma and personality disorders with chronic depression: A cross-sectional study in depressed outpatients.
abstract: OBJECTIVE
  Chronic depression has often been associated with childhood trauma. There may, however, be an interaction between personality pathology, childhood trauma, and chronic depression. This interaction has not yet been studied.
  
  
  METHODS
  This retrospective analysis is based on 279 patients contacted for a randomized trial in an outpatient psychotherapy center over a period of 18 months from 2010 to 2012. Current diagnoses of a personality disorder and presence of chronic depression were systematically assessed using the Structured Clinical Interview for DSM-IV. Retrospective reports of childhood trauma were collected using the short form of the Childhood Trauma Questionnaire (CTQ-SF). DSM-IV-defined chronic depression was the primary outcome. The association between chronic depression, childhood trauma, and personality disorders was analyzed using correlations. Variables that had at least a small effect on correlation analysis were entered into a series of logistic regression analyses to determine the predictors of chronic depression and the moderating effect of childhood trauma.
  
  
  RESULTS
  The presence of avoidant personality disorder, but no CTQ-SF scale, was associated with the chronicity of depression (odds ratio [OR] = 2.20, P = .015). The emotional abuse subscale of the CTQ-SF did, however, correlate with avoidant personality disorder (OR = 1.15, P = .000). The level of emotional abuse had a moderating effect on the effect of avoidant personality disorder on the presence of chronic depression (OR = 1.08, P = .004). Patients who did not suffer from avoidant personality disorder had a decreased rate of chronic depression if they retrospectively reported more severe levels of emotional abuse (18.9% vs 39.7%, respectively).
  
  
  CONCLUSIONS
  The presence of avoidant personality pathology may interact with the effect of childhood trauma in the development of chronic depression. This has to be confirmed in a prospective study.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01226238.
authors.affiliation: Department of Psychiatry and Psychotherapy, Lübeck University, Ratzeburger Allee 160, 23538 Lübeck, Germany philipp.klein@uksh.de.
authors.forename: Jan Philipp
authors.initials: JP
authors.lastname: Klein
authors.forename: Antje
authors.initials: A
authors.lastname: Roniger
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schweiger
authors.forename: Christina
authors.initials: C
authors.lastname: Späth
authors.forename: Jeannette
authors.initials: J
authors.lastname: Brodbeck
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000150:complications* / Q000523:psychology*; D019263:Dysthymic Disorder / Q000150:complications* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients / Q000523:psychology; D010554:Personality Disorders / Q000150:complications* / Q000523:psychology*; D012189:Retrospective Studies; D055815:Young Adult