Predictors of treatment outcomes among depressed women with childhood sexual abuse histories

The association between social class and the impact of treatment for mental health problems: a systematic review and narrative synthesis

PURPOSE

This systematic review aimed to synthesise all quantitative literature on the association between social class and the effectiveness of interventions for mental health disorders.

METHODS

Systematic literature searches (inception-March 2021) were conducted across 7 databases, and all quantitative studies meeting inclusion criteria, examining the impact of social class on access to treatment, or intervention effectiveness, or the impact of treatment on social mobility, were synthesised narratively.

RESULTS

Evidence suggests that lower social class may be associated with reduced access to primary and secondary mental health care and increased likelihood of access via crisis services, and patients of lower social class may not benefit from all mental health interventions, with reduced effectiveness. While limited, there was some indication that psychosocial interventions could encourage increased employment rates.

CONCLUSION

Social class is associated with the effectiveness of psychological interventions, and should be considered when designing new interventions to prevent barriers to access and improve effectiveness.

Differences in Demographic, Risk, and Protective Factors in a Clinical Sample of Children who Experienced Sexual Abuse Only vs. Poly-victimization

Children exposed to child sexual abuse (CSA) vary considerably with regards to their presenting concerns and treatment needs. One factor creating heterogeneity amongst children experiencing CSA is their history of experiencing other victimizations (i.e., poly-victimized or not). However, little is known about risk factors for poly-victimization as well as differences in protective factors among these two groups. Additionally, there is currently limited understanding of whether poly-victimization is associated with greater trauma symptoms in children exposed to CSA and being seen for trauma treatment. Using a clinical sample of 117 children who were sexually abused (64 CSA only and 53 poly-victimized) ranging from age 3-18 years, the current study examined demographic characteristics, abuse characteristics, trauma symptoms, and protective factors using casefile review methodology. After accounting for other risk factors, parental abuse history and protective factors were significantly associated with child poly-victimization status. Children exposed to poly-victimization were more likely to have financial concerns χ ( 1 , 115 ) 2 = 4.16, p = 0.04, parents with abuse histories χ ( 1 , 117 ) 2 = 8.93, p = 0.003, and parents with histories of mental health or substance use difficulties χ ( 1 , 117 ) 2 = 4.02, p = 0.045. Although cumulative trauma symptoms scores were higher for children who were poly-victimized compared to CSA only, t ₍₁₁₅₎ = -2.24, p = 0.03, multiple regression analyses showed that poly-victimization status was not significantly associated with child trauma symptoms after accounting for other demographic and abuse characteristics. Assessing and understanding the extent to which children exposed to CSA have experienced other forms of maltreatment is critical for identifying children who may be most at risk of poor outcomes.

Distress and Therapeutic Outcomes Among Transgender and Gender Nonconforming People of Color

Transgender and gender nonconforming (TGNC) People of Color experience stressors unique to both TGNC and racial and/or ethnic minority communities, resulting in disparities in mental health. Guided by minority stress and intersectionality theories, we examined initial anxiety and depression, as well as changes in symptoms, in 41,691 clients from the Center for Collegiate Mental Health 2012–2016 dataset. We sought to understand disparities that may exist in distress and therapeutic response between TGNC and cisgender clients. We also examined the intersection of gender and racial and/or ethnic identities to examine how these trends differ for TGNC People of Color. Results from hierarchical linear modeling indicated greater symptom severity, but a slower remission of symptoms of depression and anxiety, among TGNC clients. Interaction effects were nonsignificant; however, TGNC Clients of Color experienced more distress than either White TGNC clients or cisgender Clients of Color. On average, TGNC clients, compared to cisgender clients, utilized an additional 2.5 sessions of therapy.

Association between traumatic stress load, psychopathology, and cognition in the Philadelphia Neurodevelopmental Cohort

BACKGROUND

Traumatic stressors during childhood and adolescence are associated with psychopathology, mostly studied in the context of post-traumatic stress disorder (PTSD) and depression. We investigated broader associations of traumatic stress exposure with psychopathology and cognition in a youth community sample.

METHODS

The Philadelphia Neurodevelopmental Cohort (N = 9498) is an investigation of clinical and neurobehavioral phenotypes in a diverse (56% Caucasian, 33% African American, 11% other) US youth community population (aged 8-21). Participants were ascertained through children's hospital pediatric (not psychiatric) healthcare network in 2009-2011. Structured psychiatric evaluation included screening for lifetime exposure to traumatic stressors, and a neurocognitive battery was administered.

RESULTS

Exposure rate to traumatic stressful events was high (none, N = 5204; one, N = 2182; two, N = 1092; three or more, N = 830). Higher stress load was associated with increased psychopathology across all clinical domains evaluated: mood/anxiety (standardized β = .378); psychosis spectrum (β = .360); externalizing behaviors (β = .311); and fear (β = .256) (controlling for covariates, all p < 0.001). Associations remained significant controlling for lifetime PTSD and depression. Exposure to high-stress load was robustly associated with suicidal ideation and cannabis use (odds ratio compared with non-exposed 5.3 and 3.2, respectively, both p < 0.001). Among youths who experienced traumatic stress (N = 4104), history of assaultive trauma was associated with greater psychopathology and, in males, vulnerability to psychosis and externalizing symptoms. Stress load was negatively associated with performance on executive functioning, complex reasoning, and social cognition.

CONCLUSIONS

Traumatic stress exposure in community non-psychiatric help-seeking youth is substantial, and is associated with more severe psychopathology and neurocognitive deficits across domains, beyond PTSD and depression.

Effectiveness of interpersonal psychotherapy-trauma for depressed women with childhood abuse histories

BACKGROUND

Women with depression and childhood sexual abuse histories constitute more than 20% of the female patient population in publicly funded community mental health centers (CMHCs). Interventions are needed that address depression and posttraumatic stress disorder (PTSD) symptoms and social health.

METHOD

We compared Interpersonal Psychotherapy-Trauma (IPT-T), an IPT adaptation for this population and setting, to Clinic Psychotherapy (CP). CP clinicians were free to implement the psychotherapy of choice. Women (n = 162; 54% White, 10.5% Hispanic; 52.2% Medicaid-insured) with a major depressive episode (MDE) and history of sexual abuse before 18 were randomly assigned to IPT-T or CP. Participants were offered 16 free sessions of IPT-T or CP. Outcomes were MDE remission, improved depression (Beck Depression Inventory, Hamilton Depression Rating Scale) and PTSD symptoms (Modified PTSD Symptom Scale), and improved social health (e.g., UCLA Loneliness Scale). Weighted generalized estimating equations were used to examine outcomes at 8 (primary) and 20 (secondary) months postrandomization.

RESULTS

IPT-T led to greater improvements in PTSD symptoms and many social health indicators, including loneliness and social support, at both 8- and 20-month follow-up. Effect sizes ranged from .18 to .39 at the primary endpoint (8 months). IPT-T and CP yielded comparable improvements in depression symptoms and MDE remission.

CONCLUSION

Evidence-based psychotherapies like IPT-T are needed in CMHCs, where some of the most vulnerable patients receive treatment. With comparable findings for depression, IPT's superior improvements in social health and PTSD symptoms are cause for optimism. IPT-T should be evaluated in dissemination trials. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Associations between socioeconomic status and psychological therapy outcomes: A systematic review and meta-analysis

BACKGROUND

Socioeconomic deprivation is associated with higher prevalence of mental health problems; however, the influence of socioeconomic status (SES) on psychological therapy outcomes is as yet unclear.

AIM

To review published evidence on the association between indicators of SES (income, education, employment, neighborhood deprivation, social position) and the outcomes of psychological interventions for depression and anxiety.

METHODS

Systematic review and meta-analysis of outcomes research studies published in the last 10 years.

RESULTS

Seventeen studies including 165,574 patients measured at least one indicator of SES and its relationship with psychological therapy outcomes. Twelve of these studies found significant relationships between SES measures and mental health outcomes. Six studies focusing on employment status offered sufficient quantitative information to conduct meta-analysis. The overall effect of employment was not significant (-0.66, confidence of interval (CI) -1.33, 0.02). A sensitivity analysis (k = 5) showed a small effect (-0.22, CI -0.36, -0.09) of employment on treatment outcomes.

CONCLUSIONS

There is some evidence to indicate that socioeconomic deprivation is associated with poorer treatment outcomes, although limitations of the available data warrant treating this as a preliminary conclusion.

Development of a Multivariate Prognostic Model for Pain and Activity Limitation in People With Low Back Disorders Receiving Physiotherapy

OBJECTIVE

To identify predictors for back pain, leg pain, and activity limitation in patients with early persistent low back disorders (LBDs).

DESIGN

Prospective inception cohort study.

SETTING

Primary care private physiotherapy clinics in Melbourne, Australia.

PARTICIPANTS

Individuals (N=300) aged 18-65 years with low back and/or referred leg pain of ≥6 weeks and ≤6 months duration.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Numeric rating scales for back pain and leg pain as well as the Oswestry Disability Scale.

RESULTS

Prognostic factors included sociodemographics, treatment related factors, subjective/physical examination, subgrouping factors, and standardized questionnaires. Univariate analysis followed by generalized estimating equations were used to develop a multivariate prognostic model for back pain, leg pain, and activity limitation. Fifty-eight prognostic factors progressed to the multivariate stage where 15 showed significant (P<.05) associations with at least 1 of the 3 outcomes. There were 5 indicators of positive outcome (2 types of LBD subgroups, paresthesia below waist, walking as an easing factor, and low transversus abdominis tone) and 10 indicators of negative outcome (both parents born overseas, deep leg symptoms, longer sick leave duration, high multifidus tone, clinically determined inflammation, higher back and leg pain severity, lower lifting capacity, lower work capacity, and higher pain drawing percentage coverage). The preliminary model identifying predictors of LBDs explained up to 37% of the variance in outcome.

CONCLUSIONS

This study evaluated a comprehensive range of prognostic factors reflective of both the biomedical and psychosocial domains of LBDs. The preliminary multivariate model requires further validation before being considered for clinical use.

Self-Reported Adverse Drug Reactions, Medication Adherence, and Clinical Outcomes among Major Depressive Disorder Patients in Ethiopia: A Prospective Hospital Based Study

Background

There is paucity of data on prevalence of Adverse Drug Reactions (ADRs) and adherence and clinical outcomes of antidepressants. The present study determined the magnitude of ADRs of antidepressants and their impact on the level of adherence and clinical outcome.

Methods

A prospective cross-sectional study was conducted among depression patients from September 2016 to January 2017 at Gondar University Hospital psychiatry clinic. The Naranjo ADR probability scale was employed to assess the ADRs. The rate of medication adherence was determined using Morisky Medication Adherence Measurement Scale-Eight.

Results

Two hundred seventeen patients participated in the study, more than half of them being males (122; 56.2%). More than one-half of the subjects had low adherence to their medications (124; 57.1%) and about 186 (85.7%) of the patients encountered ADR. The most common ADR was weight gain (29; 13.2%). More than one-half (125; 57.6%) of the respondents showed improved clinical outcome. Optimal level of medication adherence decreased the likelihood of poor clinical outcome by 56.8%.

Conclusion

ADRs were more prevalent. However, adherence to medications was very poor in the setup. Long duration of depression negatively affects the rate of adherence. In addition, adherence was found to influence the clinical outcome of depression patients.

Family Social Support Modifies the Relationships Between Childhood Maltreatment Severity, Economic Adversity and Postpartum Depressive Symptoms

OBJECTIVES

This study examines the main and moderating effects of childhood abuse or neglect severity, income, and family social support on the presence of postpartum depressive symptoms (PDS).

METHODS

Participants included 183 postpartum mothers who endorsed a history of childhood maltreatment (CM) and enrolled in a longitudinal study of mother and child outcomes. Participants completed questionnaires to assess CM severity, associated societal and maternal characteristics, and depressive symptom severity.

RESULTS

The results confirm previously identified links between CM severity and PDS. Further, hierarchical linear regression analyses indicate the interaction of household income and interpersonal support from the family attenuates the relationship between CM severity and PDS. The final model accounted for 29% of the variance of PDS scores, a large effect size.

CONCLUSIONS

This study is the first to demonstrate interrelationships between income and social support on resilience to postpartum psychopathology in childhood trauma-surviving women. Social support appeared to protect against PDS for all mothers in this study while income only conferred a protective effect when accompanied by family support. For clinicians, this implies the need to focus on improving family and other relationships, especially for at-risk mothers.

Shape of change in internet based behavioral activation treatment for depression

Shape of change, sudden gains and depression spikes were examined in an online 12-session Behavioral Activation (BA) treatment for depression. Client and therapist factors related to sudden gains were examined to investigate processes associated with outcome.

METHODS

Participants were postpartum Women with Major Depressive Disorder (n=42) who received online BA supported in 30-minute telephone sessions by a mental health worker. Depression symptoms were assessed at each session and number of sessions completed were recorded by the online program. Therapist records were rated for client stressful life event and therapist concrete focus. A quadratic pattern provided the best fit with the data; a cubic pattern was a poor fit. Sudden gains, but not depression spikes, predicted lower depression scores at 17-week outcome. Women who had higher baseline social functioning, did not experience a stressful life event during therapy, and completed more online modules, but not more telephone sessions, were more likely to have a sudden gain. A concrete therapist focus was associated with sudden gains. These results extend research on trajectories of change and sudden gains to an online BA treatment and to postpartum depression, and suggest important client and therapist factors associated with sudden gains.

An epidemiologic study of childhood sexual abuse and adult sleep disturbances

Childhood sexual abuse (CSA) is linked to negative consequences, including insomnia. Few studies have examined the enduring effects of CSA on adult insomnia. Given the relationship between sleep and poor health, a better understanding of these effects has clinical implications. We used a representative adult twin sample. Both sexes were assessed with a broad CSA variable, with a subset of females (n = 424) given additional items capturing escalating physical contact and abuse characteristics. A sum score of past-month insomnia symptoms was calculated from the Symptom Checklist-90 (shortened version). Logistic regression was used to estimate the effects of CSA, physical contact, and incident characteristics on insomnia symptoms. Of the full sample (N = 8,184), 9.8% reported CSA. CSA significantly predicted insomnia symptoms in the female sample (n = 1,407; odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.35-2.06, p < .0001) but the continuum of physical contact did not. Individually, more than 1 perpetrator and feeling forced/threatened increased sleep risk, whereas having a male perpetrator (vs. female or multiple) decreased risk. These associations did not hold when combined. In the mixed-sex sample (n = 6,777), we replicated our CSA finding (OR = 1.65, 95% CI = 1.34-2.04, p < .0001) and found that female gender (OR = 1.16, 95% CI = 1.03-1.30, p = .0125), but not the gender*CSA interaction, was significant. CSA predicts adult insomnia symptoms decades after abuse, but the small sample size for incident characteristics (n = 424) resulted in limited conclusions about associated risk.

Emotional support and adult depression in survivors of childhood sexual abuse

The goals of this study were to evaluate the effects of emotional support from friends and parents at two time points (adolescence and adulthood) on adult depression in a nationally representative sample of survivors of childhood sexual abuse (CSA), and examine whether the associations were moderated by the identity of the perpetrator (parent/caregiver vs. not). Data were taken from Waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health). The study sample included 1,238 Add Health participants with a history of CSA and an equivalently sized comparison group of individuals with no history of CSA. Parental support was measured using four items from each wave that assessed the warmth of participants' relationships with their parents and their satisfaction with those relationships. Friend support in adolescence was measured using participants' perceptions of how much their friends cared about them and in adulthood using participants' self-reported number of close friends. Depression was measured using a 10-item subscale of the CES-D. Logistic regressions showed that support from friends and parents in adulthood were significantly associated with lower odds of adult depression in CSA survivors who reported non-parent/caregiver abuse. Among survivors of parent/caregiver abuse, emotional support was not significantly associated with adult depression regardless of when or by whom it was provided. In conclusion, emotional support in adulthood from friends and parents is associated with reduced odds of adult depression in CSA survivors, but only in cases where the abuse was perpetrated by someone other than a parent or caregiver.

Childhood trauma and adult interpersonal relationship problems in patients with depression and anxiety disorders

INTRODUCTION

Although a plethora of studies have delineated the relationship between childhood trauma and onset, symptom severity, and course of depression and anxiety disorders, there has been little evidence that childhood trauma may lead to interpersonal problems among adult patients with depression and anxiety disorders. Given the lack of prior research in this area, we aimed to investigate characteristics of interpersonal problems in adult patients who had suffered various types of abuse and neglect in childhood.

METHODS

A total of 325 outpatients diagnosed with depression and anxiety disorders completed questionnaires on socio-demographic variables, different forms of childhood trauma, and current interpersonal problems. The Childhood Trauma Questionnaire (CTQ) was used to measure five different forms of childhood trauma (emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse) and the short form of the Korean-Inventory of Interpersonal Problems Circumplex Scale (KIIP-SC) was used to assess current interpersonal problems. We dichotomized patients into two groups (abused and non-abused groups) based on CTQ score and investigated the relationship of five different types of childhood trauma and interpersonal problems in adult patients with depression and anxiety disorders using multiple regression analysis.

RESULT

Different types of childhood abuse and neglect appeared to have a significant influence on distinct symptom dimensions such as depression, state-trait anxiety, and anxiety sensitivity. In the final regression model, emotional abuse, emotional neglect, and sexual abuse during childhood were significantly associated with general interpersonal distress and several specific areas of interpersonal problems in adulthood. No association was found between childhood physical neglect and current general interpersonal distress.

CONCLUSION

Childhood emotional trauma has more influence on interpersonal problems in adult patients with depression and anxiety disorders than childhood physical trauma. A history of childhood physical abuse is related to dominant interpersonal patterns rather than submissive interpersonal patterns in adulthood. These findings provide preliminary evidence that childhood trauma might substantially contribute to interpersonal problems in adulthood.