Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine.
Psychol Trauma. 2019 Oct;11(7):751-759. doi: 10.1037/tra0000457. Epub 2019 Apr 8.
Childhood trauma is associated with the development of depression during adolescence. Prior research suggests that traumatic experiences may result in differential acute treatment outcomes for depressed adolescents. However, the long-term effects of trauma on treatment response remain unclear.
Participants (N = 318) with a primary diagnosis of major depressive disorder were randomly assigned to 1 of 3 treatment groups: cognitive-behavioral therapy (CBT), fluoxetine (FLX), or their combination (COMB). All participants received 36 weeks of active treatment followed by 1 year of open follow-up. We hypothesized that (a) adolescents without a trauma history would have greater symptom reduction over the course of treatment compared to those with a trauma history and (b) there would be an interaction between trauma history, treatment arm, and time such that adolescents without trauma histories in combination treatment would improve the most rapidly. Linear mixed effects modeling, factorial ANOVAs, and log-linear analyses were used to test these hypotheses.
The linear mixed effect model revealed a significant 3-way interaction of time, trauma, and treatment type. In the CBT and COMB groups, adolescents without trauma histories improved more rapidly than traumatized adolescents. In the single-time-point analyses, there were no significant differences between adolescents with trauma histories and those without trauma histories.
Whereas all treatment groups experienced significant reductions in depression regardless of trauma history, adolescents without trauma histories receiving psychotherapy demonstrated more rapid improvements in depression symptom severity. Treatment response did not differ between traumatized and nontraumatized youth at long-term follow-up. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
儿童期创伤与青少年时期抑郁的发展有关。先前的研究表明，创伤经历可能导致抑郁青少年的急性治疗结果存在差异。然而，创伤对治疗反应的长期影响仍不清楚。
患有主要抑郁障碍的参与者（N=318）被随机分配到 3 种治疗组之一：认知行为疗法（CBT）、氟西汀（FLX）或两者的组合（COMB）。所有参与者接受 36 周的积极治疗，随后进行 1 年的开放随访。我们假设：（a）没有创伤史的青少年在治疗过程中的症状缓解程度将高于有创伤史的青少年；（b）创伤史、治疗臂和时间之间存在交互作用，以至于在联合治疗中没有创伤史的青少年会最快地改善。使用线性混合效应模型、析因方差分析和对数线性分析来检验这些假设。
线性混合效应模型显示时间、创伤和治疗类型的 3 种交互作用具有统计学意义。在 CBT 和 COMB 组中，没有创伤史的青少年比创伤青少年的改善速度更快。在单次时间点分析中，有创伤史的青少年和没有创伤史的青少年之间没有显著差异。
尽管所有治疗组都经历了抑郁程度的显著降低，无论创伤史如何，接受心理治疗的没有创伤史的青少年在抑郁症状严重程度方面表现出更快的改善。在长期随访中，创伤和非创伤青少年之间的治疗反应没有差异。（PsycINFO 数据库记录（c）2019 APA，保留所有权利）。
