Environmental Stress Affects Nonpharmacologic Treatment of Depression

Childhood adversities and recent negative life events in patients receiving nonpharmacologic primary care treatment for mild to moderate depression are associated with worse treatment outcomes, according to a study published in the Journal of Psychiatric Research. Investigators state further research on mediators and moderators of outcomes for different treatment approaches is needed to inform choices between depression treatment options in primary care.

Although nonpharmacologic depression treatments available in primary care can be effective, useful prognostic factors are scarce. Additionally, childhood adversities and recent negative life events are known to increase depression risk and severity, but their impact on outcomes is understudied. The current study analyzed the impact of childhood adversities and recent negative life events on the outcomes of nonpharmacologic primary care treatment for mild to moderate depression. The prospective study included 737 adults participating in a multicenter randomized controlled trial who were receiving treatment as usual, internet-based cognitive-behavioral therapy, or physical exercise, alone or in combination with antidepressants. Outcome measures were mean scores on the Montgomery-Åsberg Depression Rating Scale (MADRS) after 3 months of intervention and treatment response after 3 months of treatment, defined as a ≥50% reduction in baseline MADRS scores.

After adjusting for potential confounders, exposure to childhood adversities was only marginally associated with higher levels of baseline depression (β=0.51; 95% CI, −0.01 to 1.02, P =.055), but at follow-up, a higher number of childhood adversities was significantly associated with severity of depression (β=0.79; 95% CI, 0.14-1.44, P =.02). Treatment response was also reduced, but the difference was not statistically significant (risk ratio [RR]=0.94, 95% CI, 0.86-1.03, P =.20). The number of recent negative life events reported was significantly associated with both increased depression severity (β=0.52; 95% CI, 0.17-0.88, P < .01) and reduced treatment response (RR=0.95; 95% CI, 0.90-0.99, P =.03). After 3 months, interactions between exposure to childhood adversities and recent negative life events did not effect depression severity (β=0.10; 95% CI, −2.12-0.41, P <.53) or treatment response (relative excess risk due to interaction= −0.04; 95% CI, −0.32-0.23, P =.78; attributable proportion due to interaction=−0.05; 95% CI, -0.42-0.32, P =.78).

Study investigators concluded, “Clinicians involved in the treatment of mood disorders in primary care settings should be mindful of the impact of environmental stress, such as negative recent life events or history of childhood adversities, and consider screening for these issues during the course of treatment when appropriate. Further research is needed to identify moderators and mediators of outcomes for different treatment options (and their combinations) in order to improve the mechanisms of these and other associations and to inform selection of treatment options for depression in primary care.”

Reference

Yacaman-Mendez D, Hallgren M, Forsell Y. Childhood adversities, negative life events and outcomes of nonpharmacological treatments for depression in primary care: a secondary analysis of a randomized controlled trial [published online January 4, 2019]. J Psychiatr Res. doi: 10.1016/j.jpsychires.2019.01.004