Childhood adversity and adulthood major depressive disorder

Examine how specific types of childhood adversity are associated with clinical features and treatment in adults with Major Depressive Disorder (MDD). This is a secondary analysis of the 35-site VA Augmentation and Switching Treatments for Improving Depression Outcomes study. A 10-item Adverse Childhood Events (ACE) survey was administered at baseline. 83% experienced at least one of the 10 ACEs and 20.7% experienced 6 or more. Participants with childhood adversities were more likely to be younger, female, unemployed, single or divorced, and to have had more severe depression and anxiety, more lifetime episodes, a younger age of first diagnosed MDD, more comorbid PTSD, worse quality of life, and more suicidal ideation than those no or fewer adversities. Neither the overall number nor any of the specific types of adversities were associated with lower remission rates after administration of standard “next-step” treatment strategies, while histories of different specific types were associated with lower depression severity, better quality of life, and less suicidal ideation post-treatment. Attention to different forms of childhood adversity and to diverse clinical outcomes beyond remission and relapse are important considerations when treating individuals with MDD with histories of childhood maltreatment. ClinicalTrials.gov identifier: NCT01421342. •Histories of adverse childhood life events are common in outpatients with major depressive disorder.•Childhood adversity is associated with a younger age of first diagnosis of major depression, lifetime suicidal thoughts, severe depression and PTSD.•Childhood adversity does not predict remission or response to “next-step” treatments for major depressive disorder.•Different types of childhood adversities are associated with distinct treatment outcomes.•Sustained clinical attention to ongoing suicide risk and focused interventions are needed for patients with MDD and histories of childhood adversity.